MATERIA MEDICA AND 
THERAPEUTICS 

A TEXT-BOOK FOR NURSES 



BY 

LINETTE A. PARKER, B.Sc. (Columbia Univ.), R.N. 

bachelor's diploma in education, teachers college; instructor in nursing 
and health, teachers college, columbia university, new york 



SECOND EDITION, THOROUGHLY REVISED 



ILLUSTRATED WITH 30 ENGRAVINGS AND 3 PLATES 




LEA & FEBIGER 

PHILADELPHIA AND NEW YORK 

1916 



T/6 



Entered according to the Act of Congress, in the year 1916, by 

LEA & FEBIGER, 
in the Office of the Librarian of Congress. All rights reserved. 




MAY 22 1916 



&CU4S8160 

1^ / - 



PREFACE TO THE SECOND EDITION. 



The demand for a second edition of this book so 
soon after its original publication is a source of grati- 
fication to the author. It is a pleasure to feel that 
success has followed this effort to give the nursing 
profession a practical text-book on Materia Medica, 
which is also sufficiently comprehensive. 

The aim of the work is to present the use of drugs 
from a scientific basis in such a way as to appeal to the 
nurse's interest. An effort has been made to give 
only the important and practical points which form a 
foundation for an intelligent handling of drugs, but not 
for prescribing them. The classification by systems 
seems the most practical from the nurse's point of view. 
In Toxicology only the striking symptoms of poisoning 
are given, because they can be more easily remembered 
than detailed descriptions. First aid treatments are 
emphasized. 

The study of Materia Medica needs to be supple- 
mented by experiments, demonstrations, and observa- 
tions in the wards. The number of experiments 
suitable for hospital class work is very limited. In the 
discussion of any drug it is important that the forms 
in which it is used as a medicine should be shown before 



iv PREFACE TO SECOND EDITION 

the class unless they are very well known. Detailed 
descriptions of the physical properties of drugs have 
in many cases been omitted, as familiarity with their 
appearance can only be gained by actually seeing them. 

An effort has been made to give a broader interest 
in this field than is obtained in the hospital and the 
sick-room. A nurse should have some conception of 
the world-wide drug industry that she may appreciate 
the work of the many trained scientific men engaged 
in it, and on the other hand, that she may be cognizant 
of the evils of patent medicines and nostrums. 

Xo drugs described in the first edition have been 
omitted in the second. The oil of chenopodium is 
included as an anthelmintic and the description of 
nitrous oxide as an anesthetic has been elaborated. 
Numerous amplifications and minor changes have been 
made to clarify the text. A diagram has been added 
to the portion of the chapter on solutions which explains 
the- method of making weak from strong solutions, 
and this part has been rewritten on the basis of the 
diagram. 

The author is again indebted to Dr. Cary Eggleston, 
of Cornell Medical School, New York City, for his 
advice and suggestions in this edition. 

L. A. P 

New York, 1916. 



CONTENTS 



CHAPTER I. 
Weights and Measures 17 

CHAPTER II. 
Solutions 27 

CHAPTER III. 
Pharmaceutical Preparations 39 

CHAPTER IV. 
Definitions 53 

CHAPTER V. 
History 55 

CHAPTER VI. 
Administration of Medicines 61 

CHAPTER VII. 
Toxicology 64 

CHAPTER VIII. 
Acids and Alkalies 69 



vi CONTENTS 

CHAPTER IX. 
Salts 75 

CHAPTER X. 
Active Principles of Medicinal Plants .... 80 

CHAPTER XL 

Drugs which Act Chiefly on the Nervous System 85 

CHAPTER XII. 
Muscular System 145 

CHAPTER XIII. 
Circulatory System 156 

CHAPTER XIV. 
Respiratory System 170 

CHAPTER XV. 
Digestive System 179 

CHAPTER XVI. 
Excretory System 200 

CHAPTER XVII. 
Drugs which Affect Nutrition 209 

CHAPTER XVIII 
Specifics 216 

CHAPTER XIX. 
Reproductive System 226 



CONTENTS vn 

CHAPTER XX. 

Drugs which Act on Skin and Mucous Membranes 230 

CHAPTER XXL 
Suggested Topics for Review 243 

CHAPTER XXII. 

Drugs of Minor Importance 247 

CHAPTER XXIII. 
Prescriptions . . 251 

CHAPTER XXIV. 
Experiments . 256 

CHAPTER XXV. 

Legislation Concerning Poisonous and Habit-forming 
Drugs . 263 

CHAPTER XXVI. 
Psychotherapy 267 

CHAPTER XXVII. 
Hydrotherapy . . 272 

CHAPTER XXVIII. 
Electrotherapy 280 

CHAPTER XXIX. 
Serums and Vaccines 288 

CHAPTER XXX. 
Ray Therapy 295 



PART I. 

PHARMACY 



CHAPTER I. 
WEIGHTS AND MEASURES. 

In the United States, unfortunately, there are in use 
several systems of weights and measures in handling 
drugs — the apothecaries', avoirdupois, household, and 
metric. The apothecaries' and avoirdupois systems, 
which have their origin and legal standards in England, 
have been in most common use, but are gradually being 
replaced by the metric system, the French system of 
measure. Household measures, cups, spoons, and the 
like, frequently have to be used in the home. 

In the work-room of every pharmacy there are sets 
of apothecaries' and of metric weights and measures. 
These are used in measuring drugs for prescriptions 
and in making up stock preparations, such as liniments, 
spirits, and solutions. On the outside counter of the 
store, however, all drugs sold in bulk are weighed 
according to the avoirdupois system. 
2 



18 WEIGHTS AND MEASURES 

METRIC SYSTEM. 

Table of Weights. 

1 gramme (Gm.) = 10 decigrammes (dg.) 
= 100 centigrammes (eg.) 
= 1000 milligrammes (mg.) 
10 grammes = 1 dekagramme (Dg.) 

100 grammes = 1 hectogramme (Hg.) 

1000 grammes = 1 kilogramme (Kg.) 

The dekagramme and hectogramme are not much 
used, large quantities being expressed as 15 Gm. 
instead of 1 Dg. and 5 Gm. The ending -me, especially 
in gramme, should always be used in spelling these 
words, because, in writing, the words grain and gram 
are easily confused. The prefixes of the denominations 
below a gramme are duplicated in our system of money 
and a comparison will help in remembering the names 
and their relation. 

1 dollar = 10 dimes 1 gramme = 10 decigrammes 
= 100 cents = 100 centigrammes 

= 1000 mills = 1000 milligrammes 

The table of weights below one gramme may be 
written as follows: 

1 gramme = 1 . 000 gramme 

1 decigramme =0.1 
1 centigramme = 0.01 
1 milligramme = 0.001 
It is then seen that each decimal place in the gramme 
represents one of the lower denominations, e. g., the 
first place is taken by decigrammes as they are one- 
tenth of a gramme and 2.3 grammes may be read 2 



METRIC SYSTEM 19 

grammes and 3 decigrammes or 23 decigrammes. 4.25 
grammes may be read 4 grammes, 2 decigrammes, 
and 5 centigrammes, or 425 centigrammes. Therefore, 
converting a figure in the metric system from one 
denomination to another is simply a matter of moving 
the decimal point, which is equivalent to multiplying 
or dividing by 10, 100, or 1000. Move it to the left if 
converting to a larger denomination, to the right if to 
a smaller. Move it one place if the denomination is 
larger or smaller by 10, two places if by 100, and three 
places if by 1000. 

If it is known that a quantity is expressed in the 
metric system the denominations are often understood 
without being written. 4.5 in the metric system is 
always grammes, 0.008 in eight-thousandths of a 
gramme, 0.8 is eight-tenths of a gramme. The denomi- 
nations, centigramme and decigramme, are not com- 
monly used, a quantity being expressed as 500 mg. 
or 0.5 Gm. instead of 5 dg., and 20 mg. or 0.02 Gm. 
instead of 2 eg. All decimal fractions are written 
with a zero at the left of the decimal point. 

Problems. 

1. Convert the following to grammes by changing the decimal 
point: 

4000 mg.; 450 dg.; 64 mg.; 9 dg. 

2. Convert the following to grammes: 

8mg.; 24 dg.; 6 dg.; 24 mg. 

3. Convert the following to milligrammes: 

4 Gm.; 5 dg.; 44 eg.; 12 Gm. 

4. Add the following and express the sum in grammes: 

4Gm.; 6 dg.; 8mg.; 12 mg. 
Solution 4 Gm. = 4 . 000 
6dg. =0.6 
8 mg. =0.008 
12 mg. =0.012 

4.620 



20 WEIGHTS AND MEASURES 

5. Add and express sum in grammes: 

(1) 8mg.; 6dg.; 4Gm.; 5 eg. 

(2) 20 dg.; 3.2 Gm.; 6mg.; 45 mg. 

6. Add and express sum in milligrammes: 

(1) 5 mg.; 9 dg.; 6 Gm.; 7 eg. 

(2) 64 mg.; 23 Gm.; 8 dg.; 5 mg. 

7. The dose of morphine sulphate is 15 mg. How many doses 
could be given from 1 gramme? 

8. The dose of strychnine sulphate is 0.001 Gm. How many mg. 
in 4 doses? 

9. The dose of hexamethylenamine (urotropin) is 250 mg. How 
many grammes would you need for 4 doses? 

10. The dose of aspirin is 3 dg. How many doses in 3 grammes? 

Tables of Volume and Length. — These are on the 
same basis as the table of weights, and can be easily 
written out from that table by substituting in the 
names of the different measures liter for gramme for 
the table of volume and meter for gramme for the 
table of length. For example, the table of volume is 
1 liter = 10 deciliters, 100 centiliters, and so on; the 
table of length 1 meter = 10 decimeters, 100 centi- 
meters, and so on. Pharmacists are sometimes called 
upon to use linear measure in making plasters of 
prescribed size; a nurse probably would never use it. 
In the table of volume the liter and cubic centimeter 
are practically the only measures in common use. 
1 liter equals 1000 milliliters and 1 milliliter is a quantity 
of water which at 4° C. would occupy 1 cubic centimeter 
of space. Therefore the term milliliter is synonomous 
with that of cubic centimeter, and the latter term is 
generally used. The common equivalents are as 
follows : 

1000 cubic centimeters (Cc.) = 1 liter (L.) 
1 Cc. at 4° C. weighs 1 gramme 

Therefore 1000 Cc. or 1 L. at 4° C. weighs 1000 
Gm. or 1 Kg. 



APOTHECARIES' SYSTEM 21 



Problems. 

1. How many Cc. of water would you measure out to get the 
following : 

60 Gm. ; 9 Kg. ; 9 dg. ; 60 mg. 

2. How much would the following quantities weigh: 

6 L.; 4.6 Cc.; 0.4 Cc; 45 Cc? 

3. How many Cc. in 2.6 L? 

4. The dose of atropine sulphate is 0.4 mg. What fraction of a 
gramme is needed to make 30 Cc of a solution in which 1 Cc would 
contain the dose? 

5. The dose of tincture of opium is 0.5 Cc. 10 Cc of the tincture 
contain 1 Gnu of opium. 12 per cent, of opium is morphine. How 
many milligrammes of morphine in one dose of the tincture? 



APOTHECARIES' SYSTEM. 

Table of Weight. 

20 grains (gr.) = 1 scruple O) 1 
3 scruples = 1 dram (3) = 60 grains 
8 drams = 1 ounce (g) =480 " 

12 ounces = 1 pound ( lb) = 5760 

The scruple is seldom used, all quantities less than a 
dram being expressed in grains. The quantity § is 
expressed by the symbol ss. When the symbols are 
used the quantity is expressed in Roman numerals 
and written after the symbol, e. g., 2 grains is written 
gr. ij; 5 drams, 5v; a half of a grain, gr. ss. 



1 About the time of Christ signs were in common use to express 
quantities. The apothecaries' signs 3, 3,5. used at -the present 
time, are believed to have originated from these, and they differ 
only slightly from the ones which in those early times designated 
about the same quantities. The abbreviations for pint (O) and for 
gallon (C) (see table of liquid measure) are derived from the Latin 
words octariu&, one-eighth of a gallon, and congius, a gallon. 



22 WEIGHTS AND MEASURES 



PKOBLEMS. 

1. How many grains in 5 iv; 3v; 5hss? 

2. Salt 5j will make how many quarts of saline solution (gr. xc 
to 1 qt.)? 

3. One Seidlitz powder contains sodium bicarbonate gr. xl. How 
many drams of sodium bicarbonate in six powders? 

4. How many drams of salt would you need to make 4 qts. of saline 
solution (gr. xc to 1 qt.)? 

5. How many ounces of mucol are needed to make 2 qts. of solu- 
tion (gr. lx to Oj)? 



Table of Liquid Measure. 

60 minims (m) - 1 fluidram (f5) 

8 fluidrams = 1 fluidounce (f 5 ) = 480 minims 
16 fluidounces = 1 pint (O) = 7,680 " 

2 pints = 1 quart (qt.) = 15,000 " 

4 quarts = 1 gallon (C) 

These symbols and quantities are written like those 
of weights: 7 minims = Ttlvij, 5 fluidounces = fgv. 
In common practice the symbols for a liquid ounce and 
dram are the same as for an ounce and dram by weight, 
it being understood that the substance is a liquid. 
For example, 5 fluidounces of alcohol are expressed 

5v. 

Problems. 

1. The dose of a solution is Tfl.xxx. This dose contains gr. 3^ of 
strychnine. How much of the drug in fgj of the solution? 

2. A solution of hexamethylenamine is labelled f§ss = gr. vj. 
How many drams of the solution would you use to give gr. ix of 
the drug? 

3. Morphine gr. vj is contained in fgj of a solution. How much 
morphine in ITlx? 

4. How many ounces of salt solution (gr. xc to 1 qt.) could be 
made with gr. xxx of salt? 

5. 3ij of a solution contain gr. j of cocaine. How much cocaine 
is given when a doctor orders TTlx of the solution. 



HOUSEHOLD MEASURES 23 



AVOIRDUPOIS SYSTEM OF WEIGHTS. 

437J grains = 1 ounce (oz.) 
16 ounces = 1 pound ( lb) = 7000 grains 
Two points of difference should be noted between 
this and the apothecaries' system of weights: (1) the 
smaller number of grains in the ounce, and (2) the 
greater number of ounces in the pound. 

Problems, 

(The weighing in the following is done by apothecaries' weights; 
the drugs bought in bulk are weighed according to the avoirdupois 
system.) 

1. A pound of salt will make how many quarts of saline (gr. xc to 
1 qt.)? 

2. Four ounces of sodium bicarbonate will make how many 
Seidlitz powders (gr. xl in each powder)? 

3. If the pharmacy nurse buys 1 oz. of trional how many powders 
of gr. x can she make? 



HOUSEHOLD MEASURES. 

60 drops (gtt.) = 1 teaspoonful (t.). 

4 teaspoonfuls = 1 tablespoonful (T). 

2 tablespoonfuls = 1 fluidounce. 

2 fluidounces = 1 wineglass. 

6 fluidounces = 1 teacup. 

8 fluidounces = 1 glassful. 
Drops, teaspoons, tablespoons, and cups vary so 
much in size that this system should never be used if 
it can be avoided. A drop of water at ordinary tem- 
perature is considered equivalent to a minim, and 
both approximately weigh 1 grain. The difference 
between a ninim and a drop can be easily demon- 



24 WEIGHTS AND MEASURES 

strated by expelling 10 minims of different fluids, 
drop by drop, from a graduated minim dropper. It 
will be seen that 10 minims make about 20 drops of 
water, about 40 drops of alcohol, and less than 20 
drops of heavy oils. Therefore, if a doctor orders 
10 minims of an alcoholic preparation, like a tincture, 
and 10 drops are given, the patient gets only a portion 
of the dose. 

Problems. 

1. State how you would measure quantities for the following 
orders using household measures: 
(a) Douche, 3J to a pint. 
(6) Injection, §ij to §iv. 



'(c) Nutritive enema: 




Malted milk, 


3ss 


Somatose, 


5i 


Water, 


5iv 


Sodium bicarb., 


gr. xx 


(d) Enema: 




White of egg, 




Glycerin, 


5ij 


Oil of turpentine 


, 3ij 


Water, 


Oj 


APPROXIMATE EQUIVALENTS. 


1 gramme 


= gr. xv 


1 cubic centimeter 


= lUxv 


1 grain 


= 0.064 Gm. or 64 mg. 


1 fluidram 


= 4Cc. 


1 dram 


= 4Gm. 


1 fluidounce 


= 30 Cc. 


1 ounce 


= 30 Gm. 


1 quart 


= IL. 



The equivalents for fractions of a grain are obtained 
by considering 1 grain equal to 60 milligrammes. Then 



USE AND CARE OF MEASURING APPARATUS 25 

gL- of a grain equals 1 milligramme and the other 
fractions in common use can be easily reckoned. 
Any measure between 1 and 15 grains or minims is 
expressed in a decimal fraction of a gramme or cubic 
centimeter. The approximate equivalents in common 
use from 1 to 15 grains are expressed in round numbers 
as in the table below. Those for minims in cubic 
centimeters are the same as grains in terms of grammes. 

1 grain = 0.064 gramme. 5 grains =0.3 gramme. 

2 " = 0.1 " 7, 7J, 8 " = 0.5 

3 " =0.2 " 10 " =0.6 

4 " =0.25 " 15 " =1.0 

Pkoblems. 

1. Express the following in grains: 

4Gm.; 24 mg.; 0.6 Gm.; 5 mg. 

2. Give the equivalents in the apothecaries' system: 

3 t.; 12 Co.; 2 Gm.; 0.6 Cc. 

3. If only a Cc. measure were available how would you obtain the 
following: 

Oj;f§v; IT.; fSiij; a glassful; § L.; 10 Gm.? 

4. With household measures how would you obtain the following: 

3iv; 2Gm.; fSss; TUxx; 1L; 20 Cc; 5j? 

5. With metric weights how would you weigh the following: 

gr. xxx ; §ss; 5ij; gr. ^V 



USE AND CARE OF MEASURING APPARATUS. 

All weights should be kept in a closed box. An 
accumulation of dust will make them inaccurate, 
especially the small ones. Small weights should be 
handled with forceps only. No weights should be so 
scrupulously cleaned as to polish off the lacquer or 
metal and thus reduce their weight. When not in use 
balances ought to be covered, and at all times kept 
clean. 



26 



WEIGHTS AND MEASURES 



Balances are gauged to weigh quantities within 
certain limits, as from 0.1 to 10 Gm., and are not accu- 
rate beyond those limits. Before using a balance 
make sure that it is in equilibrium, and that it is not in 
a draught of air. The weights should be placed on the 
pan gently, as good balances are delicately made and 
a sudden jar might injure the mechanism. 



Fig. 1. — Cup on surface of liquid. A, line at which reading is taken. 



All glass measures (no others should ever be used) 
must be held on a line with the eyes while being read. 
The surface of most liquids in a cylindrical vessel is 
cupped, as can be easily seen in a test-tube (see Fig. 1). 
All glass measures are standardized to be read at the 
base of this cup, and unless so read the quantities are 
not correctly measured. 



. CHAPTER II. 
SOLUTIONS. 

True Solution. — A true solution is a clear, trans- 
parent, homogeneous liquid having a gas, liquid, or 
solid dissolved in it. Hydrogen peroxide is an example 
of a true solution of a gas; solutions of alcohol and of 
salt are other examples of true solutions. There are 
some substances which may be thoroughly mixed with 
a liquid and the resulting mixture appear homogeneous 
temporarily but after a time the ingredients separate. 
Such mixtures are called suspensions. All emulsions 
are suspensions, as is also a common preparation called 
Compound Chalk Mixture, which is used for diarrhea. 
(See Experiment I.) 

Parts of a Solution. — There are two parts in every 
solution, the liquid which forms the bulk of the solution 
and the substance dissolved in it. . The liquid is called 
the solvent; the dissolved substance the solute. The 
most common solvent is water. Alcohol is often used, 
for example in the spirit of camphor and other spirits. 
Ether is much used in scientific laboratories and is one 
of the solvents in collodion. The solute, as stated 
above, may be a gas, a liquid, or a solid. 

Solubility. — In science no substance is considered 
insoluble, but some are much more easily soluble than 
others. The solubility of a substance varies with the 



28 SOLUTIONS 

solvent used. Oils, for example, are very slightly soluble 
in water and completely soluble in alcohol. A very 
important and practical factor which affects the 
solubility of a substance is the temperature of the 
solution when made. Most substances are more 
soluble in a hot solvent than in a cold one, and for this 
reason a given amount of boric acid, for example, can 
be dissolved more quickly in hot water than in cold. 
(See Experiment II.) 

Saturation. — When a solvent has taken up so much 
of a substance that any more added simply settles to 
the bottom, the solution is said to be a saturated 
solution at that temperature. The following table 
shows the approximate quantity required to make a 
saturated solution of some of the common substances: 



Drug. 


Apoth. weight. 


Metric weight. 


Per cent. 


Boric acid .... 


6 drams = 1 pt. 


24 Gm. = 500 Cc. 


5.0 


Borax (sodium borate) 


6 drams = 1 pt. 


24 Gm = 500 Cc. 


5.0 


Sodium bicarbonate . 


10 drams = 1 pt. 


40 Gm. = 500 Cc. 


8.0 


Sodium chloride . 


4 ounces = 1 pt. 


120 Gm. = 500 Cc. 


26.0 


Calcium oxide . 


7£ grains = 1 pt. 


0.5 Gm. = 500 Cc. 


0.1 


Sodium phosphate 


2 ounces = 1 pt. 


60 Gm. = 500 Cc. 


15.0 


Magnesium sulphate . 


8s ounces = 1 pt. 


255 Gm. = 500 Cc. 


54.0 



Method of Expressing Strength. — The strength of a 
solution may be expressed in two ways: (1) by a ratio 
such as 1 : 20, read 1 to 20, or (2) by a percentage, for 
example, 5 per cent. The term per cent, means parts 
per 100. Therefore a solution of alcohol 5 per cent, 
in strength means that in 100 equal parts of the solution 
5 are alcohol. A ratio means that in the number of 
parts expressed in the second term one part is the 
solute. That is, in a 1 to 20 solution of alcohol one 
part in every 20 is alcohol. The per cent, and ratio 



RECKONING THE PERCENTAGE STRENGTH 29 

do not represent definite quantities, such as ounces or 
pints, but express a relation between the solute and the 
whole solution. That is in any quantity of a 5 per 
cent, solution of alcohol the amount of alcohol is in the 
same relation to the whole amount of the solution as 
5 is to 100; Also in a 1 to 20 solution the relation 
between solute and the whole solution is the same as 
1 is to 20. For example in 40 Cc. of a 5 per cent, 
solution there are 2 Cc. of solute because 2 is in the 
same relation to 40 as 5 is to 100. In 16 ounces of a 
1 to 4 solution there are 4 ounces of solute, because 4 
is in the same relation to 16 as 1 is to 4. As a per cent, 
or ratio assumes that the solution is divided into equal 
parts the quantity of the solute and of the whole 
solution must be expressed in the same denomination. 
For example, in 100 Cc. of a 5 per cent, solution of 
alcohol 5 Cc. are alcohol; in 100 minims, 5 minims 
are alcohol; in 20 ounces, 1 ounce is alcohol. 

Method of Reckoning the Percentage Strength. 

The percentage strength of a solution may be 
reckoned in two ways: (1) by forming a proportion, 
or (2) by forming a fraction and taking that fraction 
of 100. 

Problem. — What is the percentage strength of a 
solution 30 Cc. of which contain 6 Cc. of solute? 
First Method: 6 : 30 : : x : 100. 
30x = 600 
x = 20 

Ans. 20 per cent. 



30 SOLUTIONS 

Second Method: Reasoning that as 6 is i of 30 the 
per cent, must be -^ of 100; the actual figuring is -^ 
or I of 100 = 20 per cent., Ans. 

Rule. — 1. Form a proportion, letting x = the per cent, 
or 2. Multiply 100 by the fraction: 
amount of solute, 
amount of the whole solution. 

Problems. 

1. If 100 Cc. of a solution contain 40 Cc. of peroxide what per 
cent, solution is it? 

2. What percentage strength are the following: 

(a) 40 Cc. of solution contain 4 Cc. of peroxide. 

(6) 90 Cc. of solution contain 3 Cc. of phenol. 

(c) 20 Cc. of dilute alcohol contain 4 Cc. of alcohol. 

(d) f gij of dilute alcohol contain 3ii.i of alcohol. 

(e) f 3hj of dilute alcohol contain Tfl.xlv of alcohol. 
CO f 3J of a solution contains TTtxij of phenol. 



Method of Reckoning the Strength by a Ratio. 

When the strength of a solution is expressed in a 
ratio the amount of the solute is compared to 1 as a 
fixed basis. That is, if 20 Cc. of a solution contain 2 
Cc. of alcohol it is said to be a 1 : 10 solution, because 
if the 2 Cc. be considered as a unit there would be 9 
other such units (18 Cc), or 10 in all. The first term of a 
ratio is always 1 and the second term has to be determined. 
It may be done in two ways: 

1. By forming a proportion: 

2 : 20 : : 1 : x 

x = 10, hence the ratio is 1:10. 

2. By reasoning that if 1 is \ of the quantity of the 
solute, the second term must be \ of the amount of the 



CONVERTING PER CENT. TO RATIO 



31 



whole solution. Then | of 20 = 10 and the ratio is 

1 :10. 

Rule. — To determine the second term of a ratio: 

1. Form a proportion letting x = the second 

term of the ratio. 

or 2. Multiply the amount of the whole solution 

1 

by the fraction, 

amount of solute. 



Peoblems. 

Express the strength of the following in a ratio: 

100 Cc. of solution contain 20 Cc. of alcohol. 



80 ounces 

60 drams 

6 pints 

rtii 

1 liter 
f3ij 
f 3J 
Oj 



40 ounces 
10 drams 

. 2 pints 

f5iv 

200 Cc. 

lUxl 

mij 
mxc 



Method of Converting Per cent, to Ratio and Vice Versa. 

Sometimes the strength of a solution is expressed in 
percentage and one wishes to express it in a ratio or 
vice versa. This may be done by forming a proportion 
in each case, letting x represent the per cent, or the 
second term of the ratio, as the case may be, or by the 
following method, which is simpler: 
To express 4 per cent, in a ratio. 

As the first term of the desired ratio is always 1 
the problem is to find the second term. 

4 per cent. = 4 parts in 100 
or = 4:100 
The desired ratio = 1 : x 
x or the second term = \ of 100 = 25 

Ans. = 1:25. 



32 SOLUTIONS 

Rule. — Take 1 as the first term and divide 100 by the 
per cent, to obtain the second term. 
To express 1 : 20 in a per cent. 

As per cent, means so many parts in 100, the per cent, 
would be as many times 1 as 100 is times 20 or 5 per 
cent. 

Rule. — Divide 100 by the second term of the ratio. 



Problems. 

1. Some solution bottles are labelled as follows. State how you 
would label them by ratios: 

10 per cent.; l.per cent.; 33 per cent.; 0.1 per cent.; 5 per 
cent. ; 0.5 per cent. 

2. State how you would mark the following labels that the per- 
centage strength may also be expressed: 

1:5; 1:20; 1:100; 1:25; 1:3; 1:40. 



Relative Strength of Solutions. 

Many nurses have difficulty in determining the 
comparative strengths of solutions, that is, whether a 
5 per cent, solution is stronger or weaker than a 2 
per cent. The principle of this * problem is the same 
as in interest on money, the larger the percentage of 
interest on an investment the greater is the income 
from it. So in solutions the larger the percent, the 
stronger the solution. 

Problems. 

1. If a series of bottles of solutions were marked as follows, how 
would you arrange them according to strength? 

5 per cent.; 20 per cent.; 2 per cent.; 3 per cent.; 0.1 per 
cent. 

2. Would it be possible to make the following solutions? 

(a) A 6 per cent, from a 2 per cent. 

(b) A 10 per cent, from a 20 per cent. 

(c) A 50 per cent, from a 20 per cent. 

(d) A 50 per cent, from a 100 per cent. 



METHODS OF MAKING SOLUTIONS 33 

If the strengths are expressed in ratios they vary 
according to the second term. It is easily seen that a 
solution which contains 1 Cc. of alcohol in 5 of water 
is stronger than one which contains 1 in 20. There- 
fore the strengths of solutions expressed in ratios vary 
inversely as the second term, i. e., the smaller the second 
term, the stronger the solution. 

Problems. 

Arrange according to strength solution bottles marked as follows: 
(a) 1:20; 1:10; 1:50; 1:1000; 1:4; 1:500. 
(6) 1:4; 20 per cent.; 50 per cent.; 1:25; 1:10; 6 per cent. 

METHODS OF MAKING SOLUTIONS. 

In pharmacy all solutions are made according to 
weight. As the kind of liquid and its temperature 
affect the weight of a given volume, the weights have 
to be reckoned according to specific gravity and 
temperature. Such accuracy in hospital work is 
unnecessary and the weight of all liquids is considered 
the same as water at 4° C. That is, 4 Cc. of water, 
alcohol, or liquid phenol is assumed to weigh 4 Gm. 
Therefore, if 1 ounce of alcohol is added to 99 ounces 
of water (a 1 per cent, or 1 : 100 solution) the solution 
will measure 100 ounces and weigh 100 ounces. If, 
however, I ounce by weight of salt is added to 99 
ounces of water the salt will dissolve and not increase 
the volume of water. In this case the finished solution 
will weigh 100 ounces, but will measure only 99 fluid- 
ounces. It is, however, a 1 per cent, solution. There 
3 



34 SOLUTIONS 

can be no uniformity in making solutions unless this 
principle is followed in practice. 

In regard to solutions, the most common problems 
for the nurse are to make a certain amount of a solution 
from crude material and to make weak solutions from 
strong ones kept in stock. In these problems no nurse 
should depend on a memorized rule but should under- 
stand the reasoning upon which it is based. 



1. Solutions from Crude Materials. 

Problem. — How much alcohol is required to make 
10 ounces of a 20 per cent. (1 : 5) solution? 

First Method. — Make a proportion letting x = 
amount of alcohol. 

a;:10::20:100 or a:10::l:5 

x = 2 ounces x = 2 ounces 

Second Method. — (a) Strength expressed in per cent 
20 per cent, means that y 2 ^ of the whole solution is 
alcohol. Hence, -ffo or \ of 10 = 2 ounces. 

(b) Strength expressed in ratio. This means that 1 
part in 5 or ^ of the whole is alcohol, hence ^ of 10 = 
2 ounces. 

RULE. — First Method. — Form a proportion, letting x 
represent the quantity of crude material. 

Second Method (a). — Strength expressed in per cent. 

given per cent. 
Multiply the amount of solution by the fraction, 

100 

(b) Strength expressed in ratio. Form a proper fraction 

pf the ratio and multiply the amount of solution by it f 



METHODS OF MAKING SOLUTIONS 35 



Problems. 

(It must be remembered that the answer is in the same denomina- 
tion as that in which the whole solution is expressed. It is often 
desirable to reduce the latter to a smaller denomination before work- 
ing the problem.) 

1. How much liquid phenol would be needed to make the following 
solutions: 

(a) 40 Cc. of a 10 per cent, solution. 
(6) Oiv of a 25 per cent, solution. • 

(c) 1 gallon (reduce to ounces) of a 1:20 solution. 

(d) 1 liter (reduce to Cc.) of a 1:40 solution. 

(e) 1 quart (reduce to drams) of a 20 per cent, solution. 

2. Calculate amounts needed in the following solutions: 

(a) 1 pint of 1 per cent, saline. 
(6) 1 quart of 1:18 boric acid. 

(c) 5j of 2 per cent, cocaine. 

(d) 30 Cc. of 1 : 6 glycerin. 

(e) 1 gallon of bichloride of mercury 1 : 1000 using 1\ gr. 

tablets. 



2. Weak Solutions from Strong Ones. 

When a weak solution is made from a strong solution 
one part of the strong solution is measured out and a 
certain number of equal parts of water is added to it. 

In diagram A, Fig. 2, to make a 25 per cent, solution 
from a 50 per cent., which is twice as strong, one part of 
water must be added to one part of stock, that is, the 
one part of stock is diluted once with water. These 
two quantities may be ounces, pints or liters but they 
must be equal, that is they must both be expressed in 
the same denomination. In diagram B as a 60 per cent, 
solution is three times as strong as a 20 per cent., 
there will be three equal parts in the finished solution, 
one of stock diluted with two of water. Therefore, 
if no definite quantity is required, the problem is simply 
to determine how many equal parts there will be in the 



36 



SOLUTIONS 



finished solution; then take one of these of stock and 
the rest of water. 

This is done by dividing the larger per cent, or 
second term of the ratios by the smaller. In the 
examples above 50 + 25 or 4 -=- 2 = 2, and 60 ^ 20 
or 5 -5- 1.7 = 3, the quotient in each case being the 
whole number of equal parts. 

Usually a definite quantity of a weaker solution is to 
be made as in the following: 




/:* 



1U7 



us 






50% 25% 60% 20% 

Fig. 2. — Examples of weak solutions made from strong solutions. 



Problem. — Make 4 pints of a 5 per cent, solution of 
phenol from a stock solution 20 per cent, in strength. 

In this case there are --$- or 4 equal parts of which 
one is stock. Hence J of 4 pints or 1 pint is the amount 
of stock required. 
Solution : 

yo" or i of 4 = 1 pt., the required amount of stock. 

If the strength of the solution is expressed in ratios 
the number of equal parts is obtained by dividing the 
second terms of the ratios , 



METHODS OF MAKING SOLUTIONS 37 

Problem. — How much 1 : 5 solution is needed to 
make 100 Cc. of 1 : 40? 
Solution — 

¥ 5 o or | X 100 = 12J Cc., Ans. 
RULE. — To determine the amount of stock solution 
required to make a definite amount of a weaker one, make 
a proper fraction of the given per cents, or the second 
terms of the ratios and multiply this by the desired amount 
of finished solution. 

Pkoblems. 

1. How much 25 per cent, solution is needed to make 30 Cc. of 
5 per cent.? 

2. How much 1 : 2 solution is needed to make 40 Cc. of 1:8? 

3. How much stock solution, 1:2, is needed to make the following? 

Oj ofl:lO 500 Cc. of l: 1000 

f5v ofi:20 1 gal. of l: 100 

fgx of 1:4 1 qt. of 1:50 

4. How much stock solution, 48 per cent., is required to make the 
following? 

500 Cc. of 1 per cent. 1 gal. of 5 per cent, 

fgxij of 4 per cent. 1 qt. of 3 per cent, 

f 3v of 12 per cent. Oj of 10 per cent. 

5. How much stock solution, 1 : 5, is required to make the following? 

50 Cc. of 5 per cent. f5iv of 1:100 

Oj of 10 per cent. 1 gal. of 5 per cent, 

f 5 ij of 1 : 40 Oij of 6 per cent. 

The following table gives quantities for the more 
common solutions: 

Solution. Apothecaries'. Metric. 

Thiersch's Solution (Borosal) : l 

Boric acid 1^ drams 6 Gm. 

Salicylic acid 15 grains 1 Gm. 

Water 1 pint 500 Cc. 

Potassium permanganate: 

1:1000 7 1 grains to 1 pt. 0.5 Gm. to 500 Cc. 

1 The quantities used in this solution are variable. 



38 SOLUTIONS 

Bichloride of mercury: 

1:1000 1\ grains to 1 pt. 0.5 Gm. to 500 Cc. 

Phenol : 

1 : 20 (5 per cent.) 6 drams to 1 pt. 24 . Cc. to 500 Cc. 

Saturated boric acid: 

1 : 20 (5 per cent.), 6 drams to 1 pt. 24 . Gm. to 500 Cc. 

Normal saline: 

T 6 o per cent. 45 grains to 1 pt. 3.0 Gm. to 500 Cc. 

In approximate measure this is a rounded teaspoonful of salt to 
a quart or liter. 

To per cent. 68 grains to lpt. 4.5 Gm. to 500 Cc. 

Equivalent approximately to one level teaspoonful to a pint. 

Dobell's Solution (Comp. Solution of Sodium Borate, N. F.) : 

Sodium borate (borax) 2 drams 8.0 Gm. 

Sodium bicarbonate 2 drams 8.0 Gm. 

Glycerin 4 drams 16.0 Cc. 

Phenol 20 minims 1.2 Cc. 

Water 15| ounces 484.0 Cc. 



CHAPTER III. 
PHARMACEUTICAL PREPARATIONS. 

Pharmacy. — Pharmacy is the art and science of 
preparing drugs for medicinal use. The forms into 
which they are made are called pharmaceutical prepara- 
tions. Laws governing pharmacies and the State 
examinations for pharmacists are becoming more and 
more rigid. For eligibility to the State examinations 
for pharmacists a person must have had a full course 
in some recognized school of pharmacy and have 
served a considerable time as an apprentice. A 
pharmacist's work is exacting and full of responsi- 
bility but to one of a scientific trend of mind it is most 
interesting. 

Legal Standards.— The legal standards for pharma- 
ceutical preparations in the L T nited States are the 
United States Pharmacopeia (U. S. P.) and the National 
Formulary (N. F.). An official drug or preparation is 
one which is described in these books. The Pharma- 
copeia is revised every ten years by a committee of 
about thirty members, who are appointed each decade 
by a national convention of physicians and pharmacists 
at Washington. The revision and publication require 
about five years. The book contains a description of 
the drugs and preparations which are of known value 
and are most used. The American Pharmaceutical 
Association publishes the National Formulary every ten 



40 PHARMACEUTICAL PREPARATIONS 

years after the publication of the new Pharmacopeia. 
It contains the formulas of many common preparations 
not included in the Pharmacopeia. These books were 
made official by the Pure Food and Drugs Act (p. 265). 

The American Medical Association publishes every 
year New and Non-official Remedies, a book which 
contains a description of new preparations and non- 
official drugs which, according to their Council on 
Pharmacy and Chemistry, are worthy of trial and 
honestly marketed. 

This Association also publishes A Hand-book of 
Useful Drugs which contains a brief description of those 
drugs and preparations considered most useful to the 
medical profession. The choice of drugs here included 
was determined by the Council on Pharmacy and 
Chemistry after lists were twice submitted to teachers 
and deans of medical schools, to state medical examiners 
and others. 

CLASSIFICATION. 

I. Solutions: 

! water, 
solution, 
mucilage, 
syrup, 
spirit, 
elixir, 
glycerite. 
oleate. 
collodion. 



c. 


Other menstrua 1 


II. Extracts: 


1. 


Infusion. 


2. 


Tincture. 


3. 


Wine. 


4. 


Fluidextract. 


5. 


Extract. 


6. 


Syrup. 


7. 


Oleoresin. 



Menstruum is the word used in pharmacy for solvent. 



CLASSIFICATION 41 



III. Other Preparations: 

A. Suspensions in water 



emulsion, 
mixture, 
liniment, 
triturate, 
ointment, 
cerate, 
pill. 

suppository. 
C. Mixtures characterized by form <{ powder. 



B. Mixtures characterized by base 



| plaster, 
paper. 



In the study of the following preparations the 
Pharmacopeia should be consulted freely for illustra- 
tions and methods of procedure. Some exceptions to 
the definitions will be noted. There are three important 
factors in every preparation: (1) form, liquid or solid; 
(2) nature, solution or extract; (3) ingredients. (See 
Experiment III, page 257, for directions for laboratory 
work) . 

Solutions. 

A. Aqueous Solutions. — Solutions of drugs in 
water have a twofold advantage: water is cheap 
and it has no medicinal action. Their disadvantage 
is that they do not keep unless the dissolved substance 
is preservative. 

(a) A water (aqua) is a clear aqueous solution of 
a volatile substance. The volatile substance may 
be a gas, as in ammonia water, but more often is a 
volatile oil, as in cinnamon water. Waters of the latter 
kind are weak preparations of a drug used as flavors. 

(b) A solution (liquor) is an aqueous solution of 



42 PHARMACEUTICAL PREPARATIONS 

a non-volatile substance, usually of an organic salt, 
such as solution of ammonium acetate. 

(c) A mucilage (mucilago) is an aqueous solution of 
a gum, such as mucilage of acacia. These preparations 
are inert medicinally, and are used for soothing applica- 
tions (demulcents) and as vehicles for potent drugs. 

(d) A syrup (syrupus) is a dense sugar solution con- 
taining a drug or some extract of a drug. 

B. Alcoholic Solutions. — The advantage of these 
preparations is that alcohol is a preservative; the 
disadvantage is that alcohol has a medicinal action of 
its own which in some cases is undesirable and which 
may affect the action of the drug dissolved in it. 

(a) A spirit (spiritus) is an alcoholic solution of a 
volatile drug, e.- g., spirit of camphor. 1 

(b) An elixir is a dilute spirit flavored and sweetened. 
Most elixirs contain 25 per cent, of alcohol, one-half 
as much as whisky, and for this reason their use is 
now largely discontinued. 

C. Other Menstrua. — (a) A glycerite (glyceritum) 
is a solution of a drug in glycerin. Glycerites keep 
well, are less irritating than alcoholic solutions, and 
because of the adhesive property of glycerin are 
used on mucous membranes when continuous medi- 
cation is desired. Glycerite of tannic acid is an 
example. 

(b) An oleate (oleatum) is a solution of a drug in 
oleic acid. Oleates, such as the oleate of mercury, are 
indicated especially for inunctions because oleic acid 

1 The terms spirits of camphor and spirits of turpentine are incor- 
rect. The singular form should be used for an individual preparation. 



CLASSIFICATION 43 

is absorbable by the skin and substances, if dissolved 
in oily solutions, enter the circulation by this channel 
more readily than in other solvents. 

(c) A collodion (collodium) is a solution of a drug 
in collodion. Collodion is a very inflammable solution 
in ether and alcohol of pyroxylin, a substance similar 
chemically to gun-cotton and celluloid. Flexible 
collodion is a mixture of Canada turpentine (Canada 
balsam), castor oil, and collodion. 



Extracts. 

The purpose of the process of extracting a drug is to 
separate the active principles from the inert, solid por- 
tion of the crude drug. The liquid used to extract any 
individual drug is determined by the solubilities of the 
active principles in that drug. For example, alcohol 
will extract the oils from a crude drug because they 
are soluble in it. The liquid extracts are, therefore, 
solutions of that portion of the crude drug which is 
soluble in the particular menstruum used for extraction. 

1. An infusion (infusum) is a liquid preparation 
made by extracting a drug with boiling water. In- 
fusions are the weakest preparations (5 per cent.) 
made by extraction. They do not keep well. 

2. A tincture (tinctura) is a liquid preparation made 
by extracting a drug with alcohol, absolute or dilute. 
According to an international agreement tinctures of 
all potent drugs are 10 per cent, in strength, that is, 
a dose of 10 minims of the tincture contains 1 grain 



44 PHARMACEUTICAL PREPARATIONS 

of the drug. 1 Most tinctures of non-potent drugs are 
20 per cent, in strength. The tinctures of ferric chloride, 
Tolu, and iodine are not true tinctures but merely 
solutions of the whole drug in alcohol. 

3. A wine (vinum) is a tincture made with wine as a 
menstruum. It is of better flavor but does not keep 
well. 

4. A fluidextract (fluidextractum) is a liquid prepara- 
tion made by extraction of a drug with a suitable 
menstruum and so made that one minim represents 
one grain of the drug or one cubic centimeter represents 
one gramme of the drug. Fluidextracts are the most 
concentrated fluid preparations, being 100 per cent, 
in strength. They have an advantage over tinctures 
because of the smaller dose and the smaller amount of 
alcohol they contain. So many of them precipitate 
in the light that they should be kept' in dark bottles 
and should not be used if much precipitate is present. 

5. An extract (extractum) is a solid or semisolid 
preparation made by evaporating a liquid extract. 
Most potent extracts are four times the strength of a 
fluidextract, i. e., 1 Gm. of an extract represents 4 Cc. 
of a fluidextract or 1 gr. of extract represents 4 minims 
of fluidextract. The extracts are used chiefly in making 
pills. 

6. A syrup (see page 42). 

7. An oleoresin (oleoresina) is an extract which 
contains the resins and oils of the crude drug. Acetone 
is the menstruum usually used for the extraction. 

1 This is the only point upon which the pharmacopeias of all 
civilized countries agree. 



CLASSIFICATION 45 

Other Preparations. 

A. Suspensions in Water. — (a) An emulsion 
(emulsum) is a suspension of an oil or resin in water 
by means of an emulsifying agent. A gum is the 
agent most used. If well made an emulsion should 
keep its homogeneity for at least six months. 

(b) A mixture (mistura) is generally a suspension of 
a solid in water. Chalk Mixture is a familiar example. 

B. Mixtures Characterized by the Base. — (a) 
A liniment (linimentum) is a liquid preparation for 
external use, containing one or more drugs mixed with 
alcohol or an oil as a base. 

(b) A triturate (trituratio) is a dry mixture of a 
drug and milk of sugar (saccharum lactis). The 
purpose of this mixture is to prepare in a usable form 
a drug the dose of which is very small. A tablet 
triturate is this mixture made into very soft and soluble 
tablets. Calomel tablets are an example. 

(c) An ointment (unguentum) is a mixture of a 
drug and a fatty base such as petrolatum (vaseline), 
lard or lanolin. 

(d) A cerate (ceratum) is an ointment whose base 
is made more firm by adding wax or paraffin. The heat 
of the body softens the base of an ointment and a 
cerate, and enables the drug to come in contact with 
the tissues. 

C. Mixtures Characterized by Form. — (a) A 
pill (pilula) is a mixture of a drug and some adhesive 
substance made in certain shapes and sizes according 
to convenience or some definite use. A very large pill 



46 PHARMACEUTICAL PREPARATIONS 

is called a bolus, a very small one a granule, a flat 
pill a troche for use in throat medication. Compressed 
pills or tablets are made by machines which press the 
dry materials into desired shapes. They are hard and 
not easily soluble. An example is ammonium chloride 
tablet. 

(6) A suppository (suppositorium) is a mixture of a 
drug and a firm base, usually cacao butter, made into 
suitable shapes for insertion into the rectum, vagina, or 
urethra. Cacao butter melts at body temperature, 
thus allowing the drug to come into contact with the 
mucous membranes. 

(c) A powder (pulvis) is a finely divided solid drug 
or mixture of drugs. If intended for internal use 
powders are dispensed in folded papers (chartulse), 
in gelatine capsules, or rice-flour wafers, (disks, cachets, 
or konseals). The capsules are swallowed dry; the 
wafers are softened first by immersing them in water. 
Effervescing powders are mixtures of a drug, sodium 
bicarbonate, tartaric acid, and sugar. The purpose 
of the sugar is to flavor; of the sodium bicarbonate 
and tartaric acid to cause the effervescence by their 
chemical reaction when in solution. A familiar example 
is a Seidlitz powder (Compound Effervescing Powder). 
Effervescing powders are more agreeable to take and 
the carbon dioxide gas formed by the chemical reaction 
is slightly stimulating to the stomach. All effervescing 
powders must be kept tightly stoppered. 

(d) A plaster (emplastrum) is a medicated adhesive 
mass spread on cloth. When applied to the skin the 
body heat softens the mass sufficiently to make it adhere. 



POSOLOGY 47 

(e) A paper (charta) is a paper covered or impreg- 
nated with some medicinal substance. A mustard 
paper (charta sinapis) is the only official paper. 

POSOLOGY. 

Posology is the study of the dosage of drugs. The 
responsibility of dosage rests wholly upon the physician. 
A nurse should always be on the alert to detect errors, 
but should never of her own accord change an order. 

There are very few rules in dosage, but it is of 
assistance to compare the usual doses of some prepara- 
tions which are fairly uniform. 



Infusions: 


5ij-iv 




60- 


-120.0 Cc. 


Exception: 

Inf. of digitalis 


5ij 






8.0 Cc. 


Emulsions : 


3j-ij 






4-8.0 Cc. 


Tinctures : 










Potent: 
Non-potent: 


Tfl,x or 

3j 


less 




0.6 Cc. 
4.0 Cc. 


Fluidextracts : 










Potent: 
Non-potent: 


5ss 






0.06 Cc. 
2.0 Cc. 


Extracts : 










Potent : 
Non-potent: 


gr. \ 
gr. ii- 


iv 





0.015 Gm. 
.1-0.25 Gm. 



The more common potent drugs are nux vomica, 
belladonna, opium, digitalis, aconite, and hyoscyamus. 
Examples of non-potent drugs are gentian, calumba, 
and cardamom, 



48 PHARMACEUTICAL PREPARATIONS 

Factors which Determine Dose. — There never can be 
any fixed dose of a drug to be given under all circum- 
stances for there are many factors which influence 
its action. The climate, the nature of the disease, the 
weight, sex, temperament, and physical condition of the 
individual all have to be considered in regulating a 
dose in any particular case. Many people are- poisoned 
by drugs which ordinarily are perfectly safe. Such a 
condition is said to be an idiosyncrasy. If a nurse 
knows that her patient has such an idiosyncrasy she 
should warn the doctor, for it is a condition which he 
could not in any way detect. 

Rules for Children. — Infants under a year old are given 

. , i 1 + i f ,. age in months, 

approximately T5" or the traction, - ot 

150 

the adult dose. There are several methods of calculat- 
ing doses for children under twelve years of age, but 
the most common is to multiply the adult dose by 

i p • a g e m years 

the traction, — — * lor example, it an adult 

age + 12 

dose is Tflxij, the dose for a child six years old is 

6^12= i X 12 or miv. 

Problems. 

1. The dose of the tincture of digitalis is 1 Cc. OUxv). What is 
dose for child two years old? 

2. The dose of morphine is 0.01 Gm. (gr. |). What is dose for 
child eight years old? Ten months old? 

3. The dose of hexamethylenamine is 0.3 Gm. (gr. v). What is 
dose in milligrammes for child six months old? Four years old? 

4. The dose of sulphonal is 1 Gm. (gr. xv). What is dose for child 
ten years old? 

5. The dose of camphorated tincture of opium (paregoric) is f§ij. 
What is dose for baby five months old? 



METHOD OF CALCULATING FRACTIONAL DOSES 49 

METHOD OF CALCULATING FRACTIONAL DOSES. 

From Tablets. — Nurses are often called upon to give 
different fractional doses from tablets of one-sized 
dose which are kept on hand. For example, it may be 
necessary to give strychnine gr. 2V when the only tablets 
on hand are gr. eV> or gr. y^o from gr. eV If the dose 
to be given is an even number of times larger than the 
tablet dose on hand, then that number of whole tablets 
can be given. In the above example, three tablets of 
gr. uV each would equal gr. yV In all other cases, 
however, the tablets have to be dissolved in a certain 
number of minims of water and a fraction of that 
quantity taken as the dose. 

Problem. — Give strychnine gr. 3V when you have 
on hand tablets gr. -£■$. 

First Step. — Determine whether the desired dose is 
larger or smaller than the dose on hand. In this case 
gr. 3V is smaller than gr. 2V In any problem the 
fraction which has the larger denominator is the smaller 
fraction. 

Second Step. — Determine what fraction of the dose 
on hand is wanted. This is done by reducing the 
fractions to a common denominator and dividing the 
desired dose by the dose on hand. 

1 2 
30 ~ 60 

20 60 

Then the desired dose is § of the dose on hand. 
4 



50 PHARMACEUTICAL PREPARATIONS 

Third Step. — Select a suitable quantity of water 
which will contain the denominator of this fraction 
an even number of times. Dissolve the tablet in it. 
The desired dose will be the fraction of this amount. 

30 minims is a suitable quantity of water in this 
case. Then if one -^ gr. tablet be dissolved in this, 
| of it, or 20 minims, will contain the desired dose, 
gr. 3*o • If the desired dose is larger than the dose on 
hand, for instance, 3 of it, first substract 1 from it and 
proceed to obtain the remaining fraction of a dose. 
To the amount of solution thus obtained add a whole 
tablet. In this case f — 1 = J. Dissolve one tablet in 
lUxl of water. J of 1Uxl is lUxx. Then add one whole 
tablet to ITlxx and you will have f of the original dose. 



Problems. 

1. If 3V gr. tablet on hand, how would you give gr. y T ? 

2. If I gr. " " « « gr. A? 

3. If I gr. " " " " gr. I? 

4. If sV g r - " " " " gr. eV? 

5. If jh gr. " " " " gr. gV? 

From Solutions. — In some hospitals the drugs com- 
monly given by hypodermic injection are kept in 
solution, a certain number of minims of the solution 
containing a certain dose. For example a solution 
bottle of morphine will be labelled Tfl,x = gr. J. In 
calculating different fractional doses in this case the 
problem is exactly the same except that the drug is 
already dissolved in a given quantity of water. 



METHOD OF CALCULATING FRACTIONAL DOSES 51 



Problems. 

1. lUx contain morphine sulphate gr. J. How many minims 
required to give gr. £? 

Solution: | is larger than f. \ = %%, I = ^. Then the 
required dose is f of Tfl.x or TTLxiij . 

2. How many minims of above solution are required to give 
morphine gr. t ] q? morphine gr. f? 

3. Tfl,x contain strychnine sulphate gr. ^. How many minims 
required to give gr. ^1 gr. ^? gr. ^? 

4. 0.6 Cc. of solution contain 2 mg. What fraction of a cubic 
centimeter would contain 1 mg.? 3 mg.? 



PART II. 

INTRODUCTION TO THE STUDY 
OF DRUGS. 



CHAPTER IV. 
DEFINITIONS. 

All knowledge in regard to drugs is included in the 
term Materia Medica. Literally translated, Materia 
Medica means a study of all the materials of medicines, 
including appliances and instruments as well as drugs. 
The term is usually used, however, to mean a study 
of the history, source, characteristics, and doses of 
drugs. The terms, drug and medicine, are used inter- 
changeably. A drug is the more comprehensive 
word, meaning " any substance other than food stuff or 
a mechanical agent which produces changes in living 
organisms" (Tyrode). If these changes are beneficial 
the drug is a medicine; if harmful, a poison. 

Pharmacy and posology have been previously de- 
scribed. Pharmacognosy is a technical study of drugs, 
including their gross, microscopic, and chemical 
structure. A pharmacognosist can identify crude 



54 DEFINITIONS 

drugs by their appearance to the naked eye, by cross- 
sections under the microscope, and by chemical tests. 
This wide knowledge has made possible standardization 
of drugs and their preparations, so that a pharmacist 
can determine whether the material he is buying is 
adulterated or below standard in strength. 1 

Pharmacology is the study of the action of substances, 
apart from foods, on living organisms. This is largely 
an experimental science carried out on the lower 
animals. It is now agreed that the action of drugs will 
be similar on animals which have a similar physiology. 
Its great contribution is in determining exact methods 
by which various drugs produce their effects and the 
action of new synthetic remedies before they are used 
on man. 

All these facts about drugs are of little use without 
a knowledge of their application to the diseases of 
man. The art and practice of administering remedies 
in the treatment of disease is called Therapeutics. 
There are various branches of therapeutics, named 
according to the agent used as a remedy. The impor- 
tant branches are Psychotherapy, the use of the mind 
over that of the patient; Hydrotherapy, the use of 
water; Electrotherapy, the use of electricity; Serum- 
therapy, the use of serums; Radiotherapy, the use of 
various kinds of rays. 



1 Read the minute description in the U. S. P. of digitalis, strych- 
nine, and the assay of fluidextract of nux vomica. 



CHAPTER V. 
HISTORY. 

The art of healing is probably as old as man. Ancient 
works of medicine show that drugs were then given 
because of some fancy or superstition in regard to their 
value, and that medical practice consisted largely in 
the invoking of spirits by priests. It is believed that 
the cross line in the sign 1$ which heads every pre- 
scription is a relic of an ancient symbol of prayer for 
the blessing of the gods on the remedy. -In early 
times in Egypt there were well-organized systems of 
medicine and a comprehensive knowledge of hygiene. 
The Mosaic laws in the Bible form a wonderful sanitary 
code eVen in the light of modern science. 

In the direct line of priest doctors in Greece, Hip- 
pocrates was born in 460 B.C. Hippocrates was a 
philosopher as well as priest, and also a great teacher. 
He founded the dogmatic school of medicine, which 
believed in treating the cause of disease instead of its 
symptoms, and this school marks the separation of 
medicine from the priesthood, the beginning of the 
modern medical art. In this sense Hippocrates is 
rightly called the " Father of Medicine." In his 
written works he mentions 265 drugs, but in his belief 
drugs were secondary to diet and external treatment. 



56 HISTORY 

His Materia Medica was made up chiefly of vegetable 
drugs and one-tenth of these were bitters. 

For nearly 2000 years after the time of Hippocrates 
there was little advance in medical knowledge, but 
during this period there are a few important names. 
Galen, a Greek living in Rome in the early Christian 
era, was a prolific medical writer who left invaluable 
records of his profession. He prepared and preserved 
in his writings many medicinal recipes. The adjective 
"galenical" derived from his name is in common use, 
"galenical" preparations being those made by physical 
processes, such as extracts, tinctures, and infusions 
in distinction from alkaloids, glucosides, and chemically 
extracted principles. Galen's idea of the action of 
drugs was very primitive. He classified all drugs 
as hot, cold, moist or dry, and he believed in curing 
by contraries, a moist drug being indicated for a dry 
condition of the mouth or skin, a hot one for a chill. 
Dioscorides, of Cilicia, about 78 a.d., wrote a Materia 
Medica in which five hundred different plants are 
described, and which is still an authority on plants 
and drugs of ancient times. 

Arabian medicine, introduced with other sciences 
into Europe in the 11th century, dominated all Europe 
for nearly two centuries. The Arabs developed schools 
of pharmacy as well as schools of medicine. They 
made new medicinal preparations and formulated 
the first known pharmacopeia. The general outline 
of pharmacy and many names and forms of drugs as 
we know them originated with the Arabs. Alcohol, 
senna, benzoin, and borax are words of Arabic origin. 



HISTORY 57 

The one name which still survives as great from the 
Arabs is Avicenna, a philosopher and physician who 
lived 980-1037 a.d. 

The predominance' of Arabian medicine in Europe 
was destroyed in the 14th century by the revival of 
the works of Hippocrates and Galen. The writings 
of these men had not before been widely known, and 
the study of them brought new information, not only 
about systems of medicine, but also about the properties 
of medicinal plants. The discovery of America also 
brought many new plants, and of more importance still 
was the introduction of chemical medicines from the 
stimulus given by a famous German doctor, Paracelsus, 
who lived 1490-1541. 

Paracelsus was an arrogant, independent man. 
Living at the same time as Luther, he was as true a 
reformer in medicine as the latter was in religion and 
education. He cast aside as worthless all previous 
medicinal writers, excepting possibly Hippocrates. He 
declared his shoe-buckles were more learned than was 
Galen or Avicenna. "The Book of Nature," he said, 
"is that which the physician should read, and to do 
so he must walk over its leaves." He went to mines 
and labored as a miner to learn of metals, not for the 
gold but for the healing of mankind; he travelled 
in all countries, and talked with boors, shepherds, 
Jews, gypsies and tramps, everywhere gathering up 
knowledge. Browning in his poem "Paracelsus" gives 
what is thought a very correct characterization 
of the man and his noble purposes. His work in 
chemistry, especially on minerals, marked a distinct 



58 HISTORY 

advance in this line, and from his time there existed 
chemical schools of medicine. Paracelsus rebelled 
against the horrible smelling and tasting concoctions 
in vogue and taught the use of tinctures and quintes- 
sences. He introduced mercury as a cure for syphilis, 
and first gave the name "laudanum" to the tincture 
of opium. 

The next century after Paracelsus, the 17th century, 
marks the first real progress since the time of Hip- 
pocrates. The sciences of chemistry and physiology 
began to develop and their teaching, along with the 
new scientific method of research, had the most pro- 
found influence on medicine. Mysticism still prevailed 
but was being gradually pushed to one side. Materia 
Medica was in a hopeless state. There were great 
numbers of drugs known and used, many of them 
absolutely inert. Coupled with this fact was the ex- 
treme confidence of the people in drugs, the number, 
bad taste, and foul smell being standards of worth. 
Consequently prescriptions were advocated containing 
from 20 to 70 different drugs, the so-called "shotgun" 
prescriptions. Disgusting remedies, such as excrements 
of animals, blood of executed criminals, moss grown on 
a human skull, and earth from a grave, were still in use. 

A man who did much to aid the advance in medical 
methods at this time was Dr. Sydenham, an English 
doctor, who is sometimes called the English Hippo- 
crates. In his lifetime he acquired no great fame 
but later generations recognized the extent of his 
influence and his name is now an eminent one in 
medical history. He advocated and used little medicine 



HISTORY 59 

but a great deal of common sense. His ideas were 
slowly disseminated, as is shown by a statement 
in a cook-book published in London in 1781, one 
hundred years later. Under care of wounds is this 
statement: "Mankind in general believes in herbs, 
ointments, and plasters. It is a fact, however, that 
nothing avails except keeping the .parts soft, clean, 
and defending them from the air. It is Nature alone 
that cures wounds." Then follow directions for 
cleansing the foreign matter from the wound. 

In the 18th century, following Dr. Sydenham, there 
were two events which greatly affected Materia Medica. 
One was the rise of Homeopathy through a Dr. Hahne- 
mann of Dresden. He believed that drugs should be 
given for the totality of symptoms present at any one 
time and that infinitesimal doses were more effectual 
than larger ones. Hahnemann exerted indirectly a 
marked influence on the medical profession in two ways : 
(1) in teaching that no two drugs should be given at the 
same time, thus counteracting the custom of wholesale 
drug-giving and, (2) in showing that disease tends to 
recovery without medical interference. 

Equally important with Hahnemann's influence 
in the 18th century was the rise of the new science of 
Pharmacology. The first work in this science was in 
1765, proving that drugs affect specific organs and 
tissues of the body. The first pharmacological labora- 
tory was established in Germany in 1850. 

The progress in medicine in the 19th century was 
phenomenal, but due largely to improvements in 
methods of investigation and diagnosis and to more 



60 HISTORY 

precise instruments for use in laboratories and in 
practise. One writer has said that the 19th century 
taught doctors what not to do, as it abolished disgusting 
and senseless remedies and the absurd practices of 
bleeding and purging. In 1805 an obscure apothecary 
in Germany, named Serturner, first isolated an alka- 
loid, morphine. His discovery is considered one of the 
greatest of the 19th century. As his method of sepa- 
rating out the alkaloid is essentially the same as used 
today, and as such alkaloids as strychnine, quinine, 
atropine, and morphine are of vital importance to 
modern medicine, his name may well be called great. 

About 1890 there was a movement called Nihilism, 
which advocated the entire abolition of all drugs. 
This represented the extreme elements in the profession, 
but from that time the sentiment has fast grown that 
drugging is no longer the chief function of the doctors. 
There is now in process of formation a new school of 
medicine which has a firm faith in a few well-tried 
drugs, such as quinine, iron, mercury, opium and 
digitalis but little or no faith in the majority of them. 
So the increased knowledge of drugs has brought two 
results, an aversion to their indiscriminate use and an 
increased confidence in their powers when in the hands 
of practitioners who understand their properties. 
The tendency at the present time is toward the use of 
fewer drugs with a better understanding of their 
action. 



CHAPTER VI. 
ADMINISTRATION OF MEDICINES. 

The fact that many medicines are deadly poisons 
should be sufficient to impress upon every nurse the 
need of great care in their administration. Many 
hospitals have a list of rules posted on the door of every 
medicine closet as a means of avoiding mistakes, but 
if each nurse will picture to herself the ruin of her 
whole after-life in case she causes the death of a patient 
by giving a wrong medicine, how can she forget to be 
careful ! 

Care of Closet. — The condition of the medicine 
closets and bottles is an important factor in avoiding 
mistakes. All poisons should be kept in rough-glass 
bottles, so that the feel o'f the bottle may be a reminder 
of extra precaution. All bottles should be well labelled 
and arranged in a systematic order. Every bottle 
should have a good stopper to prevent contamination 
from the air and to prevent evaporation in the case 
of volatile preparations. Nearly all medicines deteri- 
orate with age, and if there is any doubt about their 
condition they should be examined by a chemist or, 
if that is not feasible, should be destroyed. 

Accuracy. — While measuring medicines a nurse must 
give her whole and best attention to the task. If she 
is unusually tired because of extra duty she must 
exert double care. It is no time for conversation, 
listening to news, or attending to what others are 



62 ADMINISTRATION OF MEDICINES 

doing. Be sure that the right medicine is being given, 
then that it is measured exactly. If a doctor orders 
Tfl,x he does not want TTlxij to be given. Inaccuracy 
in measuring is sometimes due to lack of proper utensils. 
A minim dose less than ten minims cannot be measured 
accurately in an ordinary minim glass. Neither is it 
accurately measured in drops from an ordinary glass 
dropper. Either pipettes or graduated minim droppers 
should be used. 

Methods of Pouring. — The contents of a bottle are 
only as clean as the inside of the cork which is in the 
neck. To keep this clean while pouring a dose, remove 
the cork with the second and third fingers of the left 
hand, holding the backs of the fingers next to the 
bottle, and retain it between these fingers while it is 
out of the bottle. A medicine bottle is very unsightly 
if the contents have run down over the label. To avoid 
this, when pouring from the bottle, hold it with the 
label toward the palm of the hand, and wipe off the edge 
afterward. 

Preparation. — Practically all medicines, except cough 
medicines, are given diluted with water. This water 
should be very cold if the preparation is to be given 
cold; very hot if given hot. Acids and inorganic iron 
preparations should never be allowed in contact with 
metal utensils or with the teeth. Measure them in 
glass vessels, mix them with a glass rod, and give them 
to the patient through a straw or glass tube. 

Time. — Medicines which are intended to relieve 
disorders of digestion are usually given with some 
definite 'relation to meals that they may act while the 
digestive processes are going on. Irritating drugs are 



NAMES OF DRUGS 63 

given after meals that they may mix with the food and 
be kept from contact with the walls of the stomach. 
Cathartics are given according to the length of time 
that it takes them to act. The object, whenever 
possible, is to cause the bowels to move at their regular 
time, preferably early in the day. If drugs are used 
to secure a prompt action after absorption, they should 
be given between meals, at least one hour after or half 
an hour before meals. 

Oils are best given from one to two hours after meals, 
as they tend to interfere with digestion. 

Two medicines should never be given at the same 
time unless so ordered. 

Names of Drugs. — The labels of medicine bottles 
commonly bear the chemical or Latin names of the 
drugs, such as phenyl salicylate for salol and spiritus 
frumenti for whisky. The object in thus avoiding the 
popular names is usually to conceal the nature of the 
drug from patients. 

There is, however, another reason why nurses and 
doctors should be familiar with the chemical names 
of drugs. There are many drugs on the market with 
patented names, and the price of these drugs or of 
prescriptions containing them when purchased under 
the patented name are often as much as 100 per cent, 
higher than when purchased under the chemical name. 
Examples of this are thymol iodide which under^the 
name of Aristol, until the patent expired, was one of 
the most expensive drugs on the market. Hexamethyl- 
enamine can be purchased for a much lower price than 
the same drug under the name of urotropin, form in, or 
other patent name. 



CHAPTER VII. 

TOXICOLOGY. 

Toxicology is the study of the detection, action, and 
antidotes of poisons. One suspects that a poison has 
been taken when some sudden violent symptom occurs 
such as vomiting, collapse, or convulsions. The duty 
of the nurse is first to send some other person for a 
physician and before his arrival find out, if possible, 
what poison has been taken and how much, and then 
to apply suitable first-aid antidotes. Only first-aid 
antidotes are considered in this chapter. Further 
treatment is left to the physician. 

ANTIDOTES. 

Antidotes are the agents used to counteract the 
effect of a poison, and are of three kinds, physical, 
chemical, and physiological. 

A physical antidote is one which envelops the poison, 
thus preventing its absorption, and soothes and 
protects the surface of the tissues. Those which are 
soothing and protective are called demulcents. The 
following may be used as demulcents: milk, white 
of egg, boiled starch, flour and water (best when 
boiled), gruels, barley-water, mashed potato, and 
mucilage of acacia. These may all be given freely. 
The fixed oils, such as olive oil, are demulcents, but 



ANTIDOTES 65 

must be used with care for in some cases, as in phos- 
porus poisoning, they aid in the absorption of the 
drug. 

A chemical antidote is one which reacts chemically 
with the poison and breaks it down. (See Experiment 
VII, p. 261.) Care must be taken in the selection 
and amount of a chemical antidote. It must itself be 
non-poisonous and form in the reaction non-poisonous 
products. The amount to be given is determined 
by the amount of the poison taken, but if the latter is 
not known large amounts should not be given. Com- 
mon salt is a safe chemical antidote for silver nitrate, 
as both products, silver chloride and sodium nitrate, 
are relatively harmless. Other examples are lime- 
water for acids and vinegar for alkalies. Sodium 
bicarbonate and magnesium carbonate are commonly 
used as chemical antidotes for acids, but are not 
entirely safe because the chemical reaction yields 
carbon dioxide gas which by pressure might cause 
perforation of the stomach. As a rule an emetic is 
given after a chemical antidote. 

A physiological antidote is one which produces the 
opposite systemic effect from that of the poison. For 
example, caffeine is the physiological antidote for 
morphine because it stimulates the nerve centres 
which are depressed by morphine. 

General Outline of First-aid Treatment in Poisoning. 

1. Lose no time but give the best thing nearest at 
hand. 

n 



66 TOXICOLOGY 

2. For poisonous gases secure abundant fresh air 
and give artificial respiration. 

3. For non-irritant poisons give a chemical antidote, 
if one is known, and remove at once by stomach-tube, 
cathartics, emetics, and diuretics. Sometimes, as in 
cases of poisoning by alkaloids, the stomach is washed 
out with a chemical antidote, such as potassium 
permanganate. The stomach-tube, if quickly avail- 
able, is the most effective means of removing poisons. 
The best simple emetic is warm water with or without 
salt. Mustard water, copper or zinc sulphate and 
ipecac, are all more or less uncertain, slow, and irritat- 
ing to the stomach. (See Emetics, page 180.) Apo- 
morphine, gr. jo, given subcutaneously, is quick and 
sure. It is the only available emetic when a patient 
is unable to swallow. As a rule magnesium sulphate or 
citrate are the best cathartics for non-irritant poisons. 
Castor oil may be used for irritant poisons. Water 
should be given freely as a diuretic. 

4. For corrosive and irritant poisons 1 give a suitable 
chemical antidote and demulcents. If there is an 
extensive destruction of tissue the stomach-tube or 
emetics cannot be used for fear of perforation of the 
wall of the esophagus or stomach. 

5. Whenever possible avoid the use of the stomach- 
tube in the absence of the physician. 



1 Such substances are acids, alkalies, chlorides of zinc, tin, anti- 
mony and mercury, nitrates of silver and mercury, sulphates of 
copper, zinc, and iron, lead salts, and phosphorus. 



ANTIDOTES 



67 



Antidotes of Common Poisons. 







Safe Dose of 


Poison. 


Antidote. 


Antidote. 


Acids. 


Lime-water. 


1-2 glasses undiluted. 




Milk of magnesia. 


\ glass undiluted. 




Sodium bicarbonate. 


\ t. in glass of water. 




Magnesium carbonate 


Half an ounce (15 




or oxide. 


Gm.) in glass of 
milk or water. 


Oxalic acid. 


Lime-water. 1 


1-2 glasses undiluted. 


Alkalies. 


Vinegar. 


1 T (15 Cc.) in glass 
of water. 


Organic poisons (al- 


Potassium permangan- 


Claret-colored solu- 


kaloids and gluco- 


ate. 


tion, preferably fol- 


sides. See pp. 81, 




lowed by an emetic 


82). 




or use as lavage. 
Let no undissolved 
crystals enter the 
stomach. 




Hydrogen peroxide. 


\ glass of 50 per cent. 




Tannin in tea. 2 


Freely. 


Metallic salts. 


Tannin. 


As above. 




Whites of eggs. 


2-4 eggs. 




Milk. 


Freely. 


Silver nitrate. 


Sodium chloride. 


2 t. in water. 


Iodine. 


Starch. 


1:15 in water. 


Phenol. 


External use — pure al- 






cohol. 


Freely. 




Internal use — whisky. 


Preferably in the form 
of lavage diluted 
four times with 
water. 


Phosphorus. 


No oil. 






Potassium permangan- 


' 




ate. 


As above. 




Copper sulphate. 


i-1 glassful of a light 
blue solution. 


Arsenic. 


White of egg. 


Freely. 




Milk. 


Freely. 



1 This is of little use unless given at once. If none is at hand, make 
some by putting into water a piece of plastering from the wall. 

2 Add boiling water to large amounts of tea (about a handful to 
a pint). Steep for two minutes to extract the caffeine. Pour off 
this infusion and add fresh boiling water. Boil briskly for five to 
fifteen minutes according to the urgency of the case. This fluid will 
contain the maximum of tannin. 



PART III. 

STUDY OF DRUGS-MISCELLA 
NEOUS. 



CHAPTER VIII. 
ACIDS AND ALKALIES. 

Acids and alkalies 1 are used both as local and 
systemic medicines. By a local medicine is meant 
one whose therapeutic action is at the point of applica- 
tion on the skin or mucous membranes. A systemic 
medicine is one given for its action on some distant 
organ or tissue after absorption. This is sometimes 
spoken of as remote action in distinction from local. 
Gargles and salves are all local remedies. Brain 
stimulants, heart tonics and general tonics are systemic 
remedies. 

Local Physical Action. — An important local use of 
acids and alkalies is the purely physical one of supplying 
a deficiency in the alimentary canal. Hydrochloric 
acid is commonly used to supply a deficiency of hydro- 
chloric acid in the stomach, and chalk, lime-water 

1 Alkalies in this chapter include the free alkalies, sodium, potas- 
sium, and calcium hydroxide and alkali salts, such as the carbo- 
nates and bicarbonates. 



70 ACIDS AND ALKALIES 

or magnesium carbonate to supply a deficiency of 
alkali in the intestine. The former is indicated in 
certain forms of gastric indigestion, the latter in 
intestinal indigestion and diarrhea, such as the summer 
diarrhea of children, due to excessive acid fermentation. 

Local Chemical Action. — Another local use of acids 
and alkalies is based on their power of neutralizing 
each other. In excessive acidity of the stomach an 
alkali, such as sodium bicarbonate, lime-water, and 
magnesium carbonate or oxide, may be used. 

The other local uses of acids and alkalies depend 
upon two chemical properties: (1) that of withdrawing 
water from the tissues due to their affinity for it; 
(2) that of coagulating albumin from the protoplasm 
of the cells. (See Experiment IV, p. 260.) All living 
cells contain a proportionately large amount of albumin 
which is in its general characteristics like albumin of 
an egg. By heat and by various agents this albumin 
may be coagulated and it then has the same appearance 
as the white of an egg when cooked. In living tissues 
if the coagulation has not proceeded too far the albumin 
can be restored to its natural state. The white appear- 
ance of tissue around an acid burn is due to the coagu- 
lated albumin. The whitening of the hands after being 
held in even a weak solution of phenol is due to the 
same action. 

Local Therapeutic Effects. — Any agent applied to 
living cells which causes a rearrangement of their 
constituents and thus an increased activity within 
the cells is an irritant. Very often a mild irritation is 
beneficial by creating increased blood supply and 



LOCAL THERAPEUTIC EFFECTS 71 

greater nutrition, and such a mild irritation is usually 
equivalent in therapeutics to a stimulation. If, however, 
the irritation is violent, the cells are destroyed and the 
result is corrosion or cauterization. Hence weak acids 
and alkalies are stimulants and strong ones corrosives. 

As Stimulants. — In therapeutics much use is made of 
the stimulant action of acids and alkalies. Vinegar 
or other acids are used in baths to stimulate the sweat 
glands; potassium carbonate, an alkaline salt, in 
baths for dry, scaly skin affections; fruit acids such 
as lemonade and grape-juice to stimulate the mucous 
and salivary glands and allay thirst; sodium and potas- 
sium bitartrate (Rochelle salt) and magnesium citrate 
to cause catharsis by irritating the intestinal walls. 

As Caustics. — In practice only acids are used as 
caustics. The action of alkalies is with difficulty 
limited to prescribed areas. Nitric, acetic and tri- 
chloracetic acids are used for snake-bites, certain 
growths and sores on the skin; arsenous acid for 
killing dental nerves. The galvano- and thermo- 
cautery 1 have largely displaced chemicals as caustics, 
because the action is more prompt, less painful, and 
can be easily controlled. 

As Antizymotic. — Acids and alkalies are destructive 
also to certain ferments and bacteria; hence they are 
antiseptic. Boric acid is the acid commonly used 
externally. Dilute hydrochloric and phosphoric acid 
are taken before meals to check the activity of the 



1 Galvanocautery is an apparatus for cauterization by electricity. 
Thermocautery is an apparatus which by a blow flame heats a 
metal tip to red heat. 



72 ACIDS AND ALKALIES 

gastric ferments. Any drug given to check ferment 
action is called an antizymotic. Vinegar is popularly 
used for obesity for this reason. If acids or alkalies 
are taken for any reason over an extended period they 
so interfere with ferment action as to derange digestion. 
Phosphoric acid is the most easily tolerated by the 
stomach over long periods. 

As Astringents. — The albumin precipitated by 
moderately strong acids is hard and puckers the tissues. 
This constitutes a true astringent action (see p. 239). 
It is made use of in some forms of diarrhea and ex- 
ternally in tubercular night-sweats, excessive sweating 
of the feet, and itching skin diseases. Sulphuric acid 
and vinegar are used in this way. 

As Solvents. — Very weak acids and alkalies form a 
coagulated albumin which is soft and soluble, and for 
this reason they are used to soften and dissolve away 
accumulations of tough mucus in cases of diphtheria, 
croup, and catarrh of the stomach. Lactic acid or 
lime-water in a spray and the fumes of slaking lime are 
used for this purpose. Alkaline salts in baths for dry 
skin diseases act as solvents as well as stimulants. 

Systemic Effects. — On the Blood. — If more acid or 
alkali is taken into the alimentary canal than can be 
neutralized or used there, the excess does not pass 
in a free state into the blood, but in loose chemical 
combination with protein. It is quite impossible to 
give enough acid or alkali by mouth to alter materially 
the reaction of the blood. A certain degree of alkalinity 
of the blood is necessary to the life of the tissues, and 
this is maintained by a complex mechanism in con- 
nection with urea formation in the liver. 



SYSTEMIC EFFECTS 73 

On the Urine. — The administration of acids and 
alkalies do, however, affect the reaction of the urine, 
acids making it more acid, and alkalies making it less 
acid or even alkaline. Phosphoric acid, benzoic acid, 
sodium bicarbonate, and potassium acetate are in most 
common use for this purpose. 

Organic Acids. — The organic acids, 1 citric, tartaric 
and acetic, act in the same way as inorganic acids in 
the alimentary canal, but when absorbed they are 
oxidized to carbonates which are alkaline. Hence, the 
systemic action is that of alkalies. Citric acid, for 
example, will neutralize an alkali in the stomach, but 
neutralizes acid in the urine. This explains its use in 
rheumatism. 

Administration. — The dose of acids is from 1 to 15 
minims (0.1 to 1 Cc). They should be kept closely 
stoppered with glass stoppers. The alkali salts are 
given in doses of 15 to 30 grains (1 to 2 Gm.). In 
baths for stimulation the inorganic acids are used in 
the proportion of 1 ounce (30 Cc.) to a bath (30 gal. 
or 120 L.). The alkali salts, sodium and potassium 
carbonate, may be used in the strength of 3 ounces 
(100 Gm.) per bath, and sodium bicarbonate, 8 ounces 
(250 Gm.) to 1 gallon (4 L.). 

For their antizymotic action acids and alkalies are 

1 Common organic acids are lactic, tartaric, citric, salicylic, and 
acetic. Common inorganic acids are hydrochloric, sulphuric, phos- 
phoric. In chemistry all compounds are divided for convenience into 
two groups, organic and inorganic. Organic compounds contain 
carbon as one of their constituents, e. g., acetic acid (HC2H3O2) and 
lactic acid (C3H6O3). Inorganic compounds do not contain carbon, 
e. g., hydrochloric acid (HC1) and sulphuric acid (H2SO4). The car- 
bonates and bicarbonates contain carbon in their radicals, CO3, but 
they are considered inorganic compounds. 



74 ACIDS AND ALKALIES 

given before meals; to supply deficiencies, after meals. 
Some physicians prescribe an acid mixed in a glass 
of water and taken at intervals through the meal. 
In this way it is thoroughly mixed with the contents 
of the stomach. 

Cautions in Giving Acids. — Always dilute the acid. 
Prepare in a glass container and stir with a glass rod. 
Give through a glass tube. Discontinue if symptoms 
of griping and diarrhea appear. 



CHAPTER IX. 
SALTS. 

Salts must be soluble, at least in the juices of the 
alimentary canal, to be of use as systemic medicines. 
Otherwise they pass through the body without effect 
as does a coin. If they are soluble bat non-absorbable, 
such as the sulphates, they act only locally on the 
walls of the alimentary canal. 

Salt Action (see Experiment V, page 260). — An 
important action of salts depends on the principle 
of osmosis which is that if two solutions are brought 
in contact through a membrane they tend to equalize 
in concentration. The membranes in the body are 
the cell walls. These are all permeable to water and 
to some solids in solution, such as sodium chloride. 
According to this principle if cells are put into a suffi- 
ciently dilute solution of some salt they swell, because 
water passes into them from the dilute solution outside 
until the concentration inside and outside is equalized. 
Likewise if cells are put into a sufficiently concentrated 
solution they shrink, because water passes out of them 
into the concentrated solution until the two are of 
equal strength. This process in connection with drugs 
is called a salt action," because it is so marked in the 
case of certain salts, but it takes place also with almost 
any soluble substances, such as acids, alkalies, and 



76 SALTS 

sugars, and is still called salt action. The general 
effect of salt action is to change -the watery content of 
cells and this change alone is often sufficient to produce 
the desired therapeutic result. Examples of the effect 
of salt action are the watery defecations following 
administration of saline cathartics, the so-called flush- 
ing of the system by drinking large quantities of water, 
and diuresis caused by certain salts such as potassium 
acetate. 

Selective Action. — The walls of different kinds of 
cells vary in their permeability and this may account 
for the fact that when a drug is in circulation around 
all kinds of cells it acts only on one or two kinds. 
Strychnine, for instance, acts only on nerve centres, 
epinephrine on nerve endings. This is spoken of as 
the selective action of drugs. 

Chemical Action. — Many salts also exert a chemical 
action, the exact nature of which is not known. They 
may combine temporarily with constituents of the 
Cells or they may merely by their presence modify 
cell activity. 

Local Action. — The universal local action of salts 
is to break down protoplasm, forming albuminates 
and acids. Their therapeutic use depends on the 
character of these products. If the albuminates are 
soluble the drug is an irritant or caustic; if insoluble, 
it is an astringent. This is shown in the following 
equations : 



HgCL 2 + 


protoplasm 


-» HgAlb + 2HC1 


Bichloride 




Albuminate Hydrochloric 


:>f mercury. 




of mercury. acid. 



CHANGES IN THE BODY 77 

The albuminate of mercury is relatively soluble and 
hydrochloric acid is a strong acid, hence mercuric 
chloride is a corrosive. This action explains its use 
as an antiseptic. 



AgNOa + 


protoplasm 


-> AgAlb + 


HN0 3 


Silver nitrate. 




Albuminate 
of silver. 


Nitric acid 



As the albuminate of silver is less soluble than that 
of mercury and nitric acid is less strong than hydro- 
chloric, silver nitrate is a less powerful caustic than 
bichloride of mercury. 

Pb(C 2 H 3 02)2 + protoplasm -> PbAlb + 2HC2H;,02 
Lead acetate. Albuminate Acetic acid. 

of lead. 

Lead albuminate is insoluble, acetic is a weaker 
acid, hence lead acetate is an astringent. 

Changes in the Body. — When the metallic salts are 
taken internally they undergo many changes in their 
course to the cells. Iron, for instance, in whatever 
form taken becomes the chloride in the stomach, the 
carbonate in the duodenum, the albuminate in the 
blood, and the metal is probably deposited free in 
the cells. These changes very much complicate the 
administration of medicines and until a better knowl- 
edge of their nature is obtained therapeutics will fail 
to be an exact science. As the metallic part of many 
inorganic salts is desposited free in the cells, the 
action of such salts depends to a certain degree on the 
action of the metal. The salts of the more common 
metals will be considered from this point of view. 



78 SALTS 

Action of Metals. — The salts of sodium, potassium, 
calcium, and magnesium, especially of the first two, 
are much used as medicines and are seldom toxic for 
two reasons. The metals are normal constituents 
of protoplasm and their excretion is more rapid than 
their absorption. 

The salts of copper and zinc have a highly irritant 
local action, in some cases amounting to a corrosion. 
Zinc chloride is the base of many cancer cures and is 
used in legitimate medicine as a caustic for superficial 
cancers. Because they are irritants large doses of 
these salts cause vomiting before they have time to 
do much harm. Large doses, even if not vomited, 
do not cause systemic poisoning because the metals 
are excreted very rapidly. Copper in food which is 
cooked in copper utensils or tinted green by it is not 
injurious beyond a local irritation of the alimentary 
canal. 

The salts of mercury are especially toxic because 
(1) mercury is absorbed very rapidly; (2) it is corrosive 
to all kinds of tissues; (3) it is among the slowest of 
all metals to be excreted. Mercury is absorbed from 
the skin as well as from the alimentary canal. When 
absorbed it is deposited largely in the kidneys and is 
excreted from them very slowly. Fatal results are 
due primarily to injury to the kidneys. 

The salts of lead are absorbed much faster than 
excreted, hence they accumulate in the body. They 
are absorbed chiefly from the alimentary canal and 
from the lungs. Cases of lead poisoning in industry 
are due to lead-laden dust and to the failure of work- 



ARSENIC SALTS 79 

men to wash their hands before eating. Lead affects 
chiefly the circulatory and nervous systems, causing 
the varied symptoms of lead colic, anemia, neuralgia, 
and paralysis. Lead subacetate, as a local astringent, 
is the only lead salt used in medicine. 

Arsenic salts are toxic because they accumulate in 
the body like those of lead. They may be absorbed 
from the unbroken skin. In large doses they produce 
in the alimentary canal a condition resembling an 
extreme inflammation. 



CHAPTER X. 

ACTIVE PRINCIPLES OF MEDICINAL PLANTS. 

Source of Medicinal Plants. — Drug-yielding plants 
grow in all parts of the world: the valleys of Asiatic 
Turkey, the deserts of Africa, the mountains of South 
America, and various parts of Europe and North 
America. The knowledge of their medicinal value in 
many cases was first obtained from the natives by 
missionaries, explorers, and traders. A very intensive 
study has been made of these plants to determine 
the best species, the part of greatest value, and the 
most favorable conditions for their collection. The 
following outline will show the variety of sources of 
vegetable drugs. 





Part of Plant 


Chief Source of 


Drug. 


Used. 


Supply. 


Camphor. 


Wood or twigs. 


China. 


Witch hazel. 


Leaves or root. 


United States. 


Ergot. 


Fungus. 


Russia. 


Ipecac. 


Roots. 


Brazil. 


Podophyllum. 


Rhizome. 


Middle West, U. S. 


Squills. 


Bulb. 


Malta, island in Medi- 
terranean. 


Senna. 


Leaves. 


Egypt. 


Arnica. 


Flowers. 


Germany. 


Strychnine. 


Seeds. 


India. 


Capsicum. 


Fruit. 


India and Africa. 


Cascara. 


Bark. 


California. 


Opium. 


Juice of capsule. 


Asiatic Turkey. 


Turpentine. 


Exudation. 


Southern U. S. 



ACTIVE PRINCIPLES OF MEDICINAL PLANTS 81 

The increased demand for drugs has long ago 
exhausted the native supply of most of them, and the 
raising of medicinal plants is now one of the important 
industries of the world. When the desired part has 
been collected it is carefully dried and shipped to 
market usually in this crude dry form. The great 
crude drug markets of the world are London in England, 
New York in the United States, Hamburg in Germany, 
Trieste in Austria, and Marseilles in France. All crude 
drugs coming into the United States are examined 
at the point of entry by the Department of Agriculture, 
and the careful work of that department in recent 
years has practically checked the importation of 
adulterated drugs. 

Active Principles (see Experiment VIII, page 261). — 
Within the last century chemists have found that the 
medicinal action of a plant is due to one or more of 
its chemical constituents. The constituents which 
determine the action of a plant are called its active 
principles. The chief classes of active principles are 
oils, glucosides, alkaloids, resins, tannins, and saponins. 
If the active principle of a plant can be isolated and 
given pure as a medicine its action is usually more 
prompt, more reliable, and freer from side actions 
than preparations of the whole plant from which it is 
derived. The chief active principle of opium is mor- 
phine, and gr. \ of morphine is more effective than 
one grain of opium. 

Oils. — The oils used in medicine are the fixed and 
volatile oils. These differ in that the volatile oils are 
entirely volatilized bv heat while the fixed oils are 



32 ACTIVE PRINCIPLES OF MEDICINAL PLANTS 

decomposed by it. Linseed, cod-liver, and olive oils 
are examples of fixed oils. They are used in medicine 
as nutrients and as demulcents. Examples of volatile 
oils are the oils of peppermint, wintergreen, turpentine, 
and cloves. Because of their aroma they are used as 
flavors; because of their volatility and consequent 
power of penetration they are irritants and mild stimu- 
lants. The irritant action of a mustard plaster is due 
to the volatile oil of mustard. The value of oil of 
peppermint in colic is due to its slight stimulation of 
the mucous membrane of the alimentary canal. Volatile 
oils are sometimes called essential oils from an early 
belief that the chief value of a plant was its oils. An 
essence such as the essence of peppermint is an alcoholic 
solution of a volatile oil and in pharmacy is known as 
a spirit. 

Glucosides. — A glucoside is defined as a substance 
which when acted upon by an acid yields glucose or 
sugar as one of its decomposition products. The name 
usually ends in -in. Examples are digitalin, a glucoside 
of digitalis, and salicin, a glucoside from willow and 
poplar trees, sometimes used as a substitute for 
salicylates in rheumatism. 

Saponins. — Saponins are compounds which foam 
when agitated with water. They are non-absorbable, 
hence act only locally and they are powerful gastro- 
intestinal irritants. The action of sarsaparilla is largely 
due to a saponin. Quillaja, soap bark, was used as an 
emetic because of the irritant action of its saponin 
on the stomach. 



ACTIVE PRINCIPLES OF MEDICINAL PLANTS 83 

Alkaloids. — The alkaloids are defined as organic 
bases which contain nitrogen. The common alkaloids 
are here given with their chemical formulae to show 
their similarity of composition. 

Morphine C17H19NO3 

Strychnine C21H22N2O2 

Cocaine C17H21NO4 

Atropine C17H23NO3 

Quinine C20H24N2O2 

Nicotine C10H14N2 

Epinephrine C9 H13XO3 

Their names end in -ine to distinguish them from 
glucosides. They are bitter to taste, slightly alkaline 
in reaction, most are insoluble in water, but react 
with acids to form soluble salts. For this reason the 
soluble salts, morphine and strychnine sulphates for 
example, are used as medicines instead of the alkaloids 
themselves. The salts in solution are broken down 
by the oxidizing agent, potassium permanganate, and 
it acts as an antidote to them in cases of poisoning. 
Tannic acid, usually given in the form of tea, is another 
antidote. It reacts with the salts of the alkaloids and 
forms insoluble compounds. If salts are formed from 
the halogen acids, hydrochloric, hydrobromic, and 
hydriodic, the hydro- prefix in the name of the acid is 
retained in the name of the salt. Examples are cocaine 
hydrochloride and homatropine hydrobromide. There 
is a tendency among recent writers to drop the prefix. 

Resi?is. — Resins are . compounds which are soluble 
in alcohol but insoluble in water. Solid resins are 
brittle and resemble rosin, the resin in turpentine,, 
used by violinists. Resins are local irritants and are 



84 ACTIVE PRINCIPLES OF MEDICINAL PLANTS 

commonly used in medicine as cathartics. Examples 
are podophyllin, the resin of podophyllum, and the 
resins of gamboge and jalap. A substance composed 
of a resin and a gum is a gum resin of which myrrh 
and asafedita are examples. A resin combined with a 
volatile oil forms an oleoresin. Crude turpentine 
is a natural oleoresin composed of the oil of turpentine 
and rosin. 

Tannins. — It is impossible to define tannins as their 
composition is unknown. An important property of 
tannins is that they form insoluble compounds with 
alkaloids, as stated above. They also form insoluble 
compounds with albumins, hence are astringent in 
action. The most common drug of which tannin is the 
active principle is hamamelis. The only rational use 
of hamamelis is as an astringent. 



PART IV. 

STUDY OF DRUGS BY SYSTEMS. 



CHAPTER XL 

DRUGS WHICH ACT CHIEFLY ON THE 
NERVOUS SYSTEM. 

An exact arrangement of drugs, by systems or by 
classes is impossible as many of them fall into more 
than one system or class. 

Types of Drug Action. — The physiological action of a 
drug means the action which it has on a healthy 
animal. Some drugs act differently on a healthy 
organism than on a diseased one. Caffeine, for instance, 
does not affect a normal brain but will stimulate a 
tired brain. The action of a drug on a diseased organism 
is called its therapeutic action. Usually the physio- 
logical action and the therapeutic action of a drug 
are the same. 

Drugs are said to be synergistic when they have a 
similar effect on an organ, antagonistic when they 
have the opposite effect. (See page 94.) Many drugs 
have actions besides those for which they are given, 
some being very undesirable. Morphine given to 



86 DRUGS WHICH ACT ON NERVOUS SYSTEM 

relieve pain often causes nausea; atropine given to 
check sweating will cause dryness of the throat. These 
undesired effects are called side actions, and if they are 
disagreeable are termed untoward actions. 

When the exact method of action of a drug is not 
known and it is used because experience has proved 
it beneficial in similar cases, it is said to be an empiric 
remedy or to have an empirical use. A rational remedy 
is one the method of action of which is understood. 

Methods of Action. — The diagram on page 87 is 
given to assist in understanding the drugs which act 
upon the nervous system. Some act wholly on the 
central system, some on the nerve endings or periphery, 
and some on both. In the central system are located 
limited areas of nerve cells which have control of certain 
definite functions. These are called the nerve centres. 
In the brain are the higher centres which control the 
will, thought, and consciousness and through these 
the whole body; in the medulla are . the so-called 
"vital centres," the respiratory which controls the 
respiration, the accelerator which increases the heart 
beat, the vagus which slows the heart, the vomiting 
centre which controls emesis, the vasomotor centre 
which when stimulated causes the walls of the arteries 
to contract and when depressed causes them to dilate, 
and probably a heat centre. No attention should be 
paid to the relative location of these centres. It is 
important to remember simply that they are in the 
medulla. In the spinal cord are the reflex centres 
which control most reflex acts and the motor centres 
which regulate muscular activity. 



METHODS OF ACTION 



87 



Some of the nerve trunks which leave the central 
system pass through the sympathetic ganglia and some 



Central Sympathetic 
system system 



Periphery 



Motor OCuli (contracts pupil) 
dilat^JPiA- 




Fig. 3. — Diagram of the nervous system. (Modification of dia- 
gram by Meyer and Gottlieb.) The nerves which do not pass through 
the sympathetic system are in dotted lines. The functions of some 
of the branches are not understood at all and others are in dispute. 



do not. (See diagram.) On the whole these two sets 
of nerves are antagonistic to each other in action. 



88 DRUGS WHICH ACT ON NERVOUS SYSTEM 

There must be some distinct difference between them 
because some drugs act on the endings of one kind only 
(see Atropine, page 96, and Epinephrine, page 159). 

Drugs affect nerve cells in only two ways: they 
either stimulate or depress them. A stimulating drug 
increases the function of the centre or ending upon 
which it may act; a depressant drug lessens the func- 
tion. For example, if a drug stimulates the accelerator 
centre the heart beats faster, if it depresses it the heart 
beats more slowly. A general condition of stimulation 
is characterized by excitability, alertness, restlessness, 
and a quickened heart and respiration. Overstimula- 
tion of the central system often leads to convulsions. 
The characteristic features of a general depression are 
lack of attention to surroundings, quiescence, dull 
eyes, and a slow pulse and respiration. Excessive 
depression of the central system ends in delirium or 
stupor, paralysis, coma, and death usually by paralysis 
of the respiratory centre. 

The classes of drugs which act on the nervous 
system will be considered in the order given in the 
following classification : 

Action on Central Nervous System: 

Central stimulants. General anesthetics. 

Central depressants. Analgesics. 

Hypnotics. 
Action on Periphery: 

Local anesthetics. Mydriatics. 

Anodynes. Myotics. 

Antispasmodics. 



ACTION ON THE CENTRAL NERVOUS SYSTEM 89 



ACTION ON THE CENTRAL NERVOUS SYSTEM. 

Central Stimulants. 

Strychnine. — History. — Strychnine is an alkaloid de- 
rived from the seeds of nux vomica, 1 a small straggling 
tree of India and parts of China. The seeds are 
imbedded in a pulpy fruit resembling a small orange. 
Nux vomica was unknown in ancient medicine and 
was probably brought to Europe by the Arabs. The 
first description of it in medical literature of Europe 
was about 1640. It was then said to be of great use 
"to kill dogs, cats, crows, and ravens, but of little use 
in medicine." The alkaloid was discovered about 1820 
and has largely supplanted the drug from which it is 
derived. Nux vomica is now used only as a convenient 
form in which to give strychnine when a prolonged 
action is desired. 

Action on Cord. — The action of strychnine is to 
stimulate the central nervous system, small doses 
affecting chiefly the cord and large doses affecting also 
the medulla. In toxic doses it continues to stimulate 
these centres to the point of convulsions, but between 
the convulsions there is excessive depression, and 
death is due to paralysis of the respiratory centre. 
In the spinal cord the action of strychnine is confined 
chiefly to the reflex centres, making them more receptive 

1 The following crude drugs are of special interest for demonstration 
when their action is being studied; nux vomica seeds, stramonium 
leaves, opium capsule, methyl alcohol, digitalis leaves, ipecac roots, 
quassia chips, podophyllum rhizome, senna leaves, cascara bark, 
rhubarb rhizome, theobroma nuts, ergot, Spanish flies. 



90 DRUGS WHICH ACT ON NERVOUS SYSTEM 

to impulses coming to them and more active in trans- 
mitting impulses to the motor areas. There follows, 
therefore, an improvement of all functions which are 
reflex in character — respiration, heart action, digestion, 
and nutrition; and, as a result of this, an increased 
tone of all muscles and a general state of well-being. 

Action on Medulla. — When the dose of strychnine 
is sufficiently large to act upon the medulla, the respira- 
tory centre is chiefly affected and to some extent the 
vasomotor. Strychnine has no direct action on the 
heart and its slight stimulation of the vasomotor 
centre has little affect on blood-pressure. Therefore 
when blood-pressure is very low, as in shock, it is of 
little value. In small repeated doses as a tonic the 
circulation is benefited indirectly by the improved 
general condition. The central nervous system itself 
is not directly benefited by strychnine, but indirectly 
as is the circulation. Because of its bitter taste strych- 
nine, like any bitter, improves digestion. 

Therapeutic Uses. — The therapeutic uses of strych- 
nine are based directly on its physiological action. 
They may be summarized as follows: 

1. In large doses in crises to improve respiration 
and blood-pressure. 

2. In smaller doses over prolonged periods as a gen- 
eral tonic. 

3. In constipation, diarrhea, and indigestion, to 
improve the muscular tone of the alimentary canal. 

•4. As a bitter to improve gastric digestion. 
5. As an antidote to central depressants such as 
ether and chloroform. 



PLATE I 




Stryehnos Nux Vomica— Poison Nut. 
(Courtesy of Parke, Davis & Co.) 



ACTION ON THE CENTRAL NERVOUS SYSTEM 91 

Dosage. — Strychnine sulphate is the salt usually 
used. As a tonic it is given in doses from gr. ^ (1 mg.) 
to gr. 3u (2 mg.); as a stimulant from gr. ^ (2 mg.) 
"to gr. 20 (3 mg.). The fatal dose is J grain or more. 
Strychnine is an ingredient of Compound Laxative 
Pills (A. S. and B. pills), each pill containing about 
gr. 125 (0-5 m g-)- It also enters into the composition 
of many tonic preparations such as Elixir of Iron, 
Quinine, and Strychnine Phosphates. 

Preparations of mix vomica are preferred when a 
prolonged effect is desired, as in disorders of the 
alimentary canal, because they are absorbed slowly. 
The tincture is commonly used as a tonic. The average 
doses are in accordance with the general rules on 
page 47. 

Tincture (10 per cent.) lUx (0.6 Cc.) 
Extract gr. | (0.015 Gm.) 

One grain (0.06 Gm.) of nux vomica contains approxi- 
mately gr. ioo (0.6 mg.) of strychnine, hence each 
dose of the above preparations contains gr. xqo (0-6 
mg.) of strychnine. 

Toxicology. — Even therapeutic doses may occasion- 
ally be followed in 15-30 minutes by nervousness 
and twitching of the muscles, and these symptoms 
should be reported. Moderate overdoses will cause 
the same symptoms. Toxic doses usually cause 
within fifteen minutes a sudden convulsion. As it is 
the reflex centres which are overstimulated the slightest 
sound, touch, or bright light will cause a convulsion. 



92 DRUGS WHICH ACT ON NERVOUS SYSTEM 

The spasms are intermittent alternating with periods 
of extreme depression. If treatment can be begun 
before the onset of convulsions, the stomach should 
be washed out with potassium permanganate or tea. 
If lavage is impossible give the antidote and an emetic. 
If convulsions have already set in, only symptomatic 
treatment can be given. Artificial respiration and 
inhalation of oxygen are the best measures to relieve 
the convulsions and the depression of the respiratory 
centre. Morphine must not be given for it increases 
the depression. Chloroform may be administered 
during a convulsion, but with great care lest it, too, add 
to the depression which is sure to follow the spasm. 

Caffeine. — Source. — Caffeine is a white crystalline 
substance usually obtained in commerce from damaged 
tea leaves. It is the active principle of many plants 
used as beverages, such as coffee, tea, kola in Africa, 
guarana in South America, and Paraguay tea. 

Action on Nervous System. — Whereas strychnine in 
small doses acts chiefly on the cord, caffeine stimulates 
chiefly the higher centres, causing wakefulness and in- 
creased mental efficiency. Large doses stimulate the 
medulla and cord, but on account of the extreme wake- 
fulness and nervousness resulting it is less useful than 
strychnine for this action. In treatment of poisoning 
by depressants, however, caffeine is better than strych- 
nine, because it is a pure stimulant to the higher 
centres and does not end in depression. 

Action on Muscles. — In small doses caffeine stimulates 
the muscles, increasing their power to do work; in 
large doses such as are taken in the excessive use of 



ACTION ON THE CENTRAL NERVOUS SYSTEM 93 

coffee as a beverage it has the opposite effect, causing 
a condition in the heart like fatigue with palpitation 
and intermissions. In treatment of depressant poisons 
the dose must be regulated to avoid this action on the 
heart. 

Diuretic. — In certain conditions caffeine is an active 
diuretic, that is, a drug which increases the flow of 
urine. This has been shown to be due in part to a 
local action on the kidneys, as it takes place equally 
well in an isolated kidney. (See Caffeine, page 205.) 

Therapeutic Use. — Because of the stimulant action 
of caffeine on the cerebral centres it is used in head- 
aches, mental fatigue and depression, and as an antidote 
to depressant drugs such as morphine and alcohol. 
It is especially useful as a diuretic in cases of cardiac 
dropsy and is considered a valuable item in a soldier's 
diet to increase muscular endurance. 

Administration. — The average dose of caffeine is 
about 2 or 3 grains (0.1-0.2 Gm.). It is often given 
in the form of coffee. An ordinary cup of coffee or 
tea contains from 1 to 2 grains (0.06-0.1 Gm.). 
Coffee as a beverage increases mental capacity in 
fatigue but not in normal conditions. The stimulation 
of caffeine in coffee and tea is increased by the volatile 
oils which give them their flavor. The tannin con- 
tained in both tends to derange digestion. In the 
roasting of coffee a highly irritating oil is formed which 
also disturbs digestion and may have a laxative effect. 
Citrated caffeine is a mixture of caffeine with an equal 
part of citric acid to make it more soluble. The dose 
is 2 grains (0.1 Gm.). The dose of Effervescent Citrated 



94 DRUGS WHICH ACT ON NERVOUS SYSTEM 

Caffeine is J-2 drams (2-8 Gm.). Caffeine with sodium 
benzoate or salicylate are other mixtures which render 
the caffeine more soluble and they are well adapted 
to hypodermic use. The dose is 2 grains (0.1 Gm.) 
Caffeine is an ingredient of Compound Acetanilid 
Powder, a headache remedy. The two drugs, caffeine 
and acetanilid, are synergistic in their effect on the 
headache but caffeine increases the toxic action of 
acetanilid on the heart. (See page 132.) 

Toxicology. — An excess of caffeine, pure or in coffee, 
causes nervousness, mental depression and palpitation 
or intermittent action of the heart. Toxic doses may 
result in strychnine-like convulsions. The treatment 
is removal of the poison and absolute rest. 

Camphor. — Source. — Camphor is a tough, white, 
crystalline substance derived from the camphor tree, 
a handsome evergreen in China and Japan. It used 
to be obtained wholly by distillation of the wood, 
but it has been found that the twigs, leaves, or even 
sap yield as good a product and they are now being 
used in order to save the trees. Artificial camphor 
is made in large quantities in Germany and to some 
extent in this country. 

Action and Use. — Locally camphor is a mild stimulant, 
antiseptic, and counter-irritant. It has a wide use in 
liniments (camphorated oil) and in the form of the 
spirit or the water for gastro-intestinal disorders. The 
dose of the spirit is 15 minims (1 Cc.) given on sugar; 
of the water about 2 drams or 10 Cc. Camphor is an 
ingredient of soap liniment, chloroform liniment, and 
several diarrhea mixtures such as Sun Cholera Drops 



ACTION ON THE CENTRAL NERVOUS SYSTEM 95 



and Squibb's Diarrhea Mixture. The systemic action 
of camphor is that of a central stimulant. Therapeutic 
doses (2 grains — 0.1 Gm.) affect chiefly the brain and are 
useful in some forms of hysteria. In even larger doses 
in olive oil or alcohol it is given intramuscularly as a 
heart stimulant in crises. If the first dose has good 



Br' 

,i3 BfePiHR. ■ 






my 


'jmft® 


fc 




1 Jp Wk 11 

timmmm^ 



Fig. 4. 



-Camphor tree grown in Florida. From U. S. pamphlet. 
"Camphor cultivation in the United States." 



results it will prove a valuable stimulant; if not, 
repeated doses are useless and even unsafe. 

Atropine. — History. — Atropine is an alkaloid from the 
leaves and roots of belladonna, a native plant in 
southern Europe. A certain amount of belladonna 



96 DRUGS WHICH ACT ON NERVOUS SYSTEM 

in the market is obtained from northwestern United 
States. The name belladonna was derived from an 
early use of the drug by beautiful women of Italy to 
produce a lustre of the eyes. Atropine was named by 
tKe famous botanist, Linne, for Atropos, the mythical 
fate who cuts the thread of life. 

Central Action. — Atropine acts chiefly on the vital 
centres of the medulla, especially the respiratory 
centre. It stands on the borderline between central 
stimulants and central depressants, because while 
it stimulates in therapeutic doses, if certain rather 
narrow limits of dosage are exceeded, the stimulation 
passes to depression, and large doses cause complete 
depression and paralysis. Because of this early 
tendency to depression atropine is not a drug for a 
nurse to use without orders. The doses have to be 
carefully regulated and even in treatment of poisoning 
large doses cannot be repeated at frequent intervals. 
Cases of morphine poisoning in which atropine was 
used as a physiological antidote are on record where 
the patients recovered from the effects of the morphine 
only to die later from depression by the atropine. 
In cases of mental excitement and insanity atropine 
seems to have a very fleeting stimulating action on the 
brain centres followed by a beneficial depression which 
quiets the mania. For its stimulant action on the 
respiratory centre atropine is used in moderate doses 
before anesthesia, in crises, and as an antidote to 
central depressants. 

Peripheral Action. — The most important uses of 
atropine are based on its effect on nerve endings. 



ACTION ON THE CENTRAL NERVOUS SYSTEM 97 

Whether used locally or internally atropine paralyzes 
the endings of all nerves which do not pass through the 




Fig. 5. — Belladonna plant. Grown in the New York Botanical 
Garden, Bronx Park, New York City. 



sympathetic ganglia. (See diagram, page 87.) As a 
result it accelerates the heart, it dilates the pupil of 
the eye, it diminishes the secretion of sweat, mucus, 

7 



98 DRUGS WHICH ACT ON NERVOUS SYSTEM 

saliva, gastric juices, and milk, and tends to relax 
overcontracted involuntary muscles in spasmodic con- 
ditions as in asthma, colic of the bile ducts, stomach, 
intestines or kidney, and spasms of the heart, bladder, 
or uterus. When applied locally atropine also paralyzes 
sensory endings and is used in solutions, ointments, 
and plasters of belladonna for neuralgia, pleurisy and 
lumbago to relieve pain. Atropine can be absorbed 
through the skin, and while being used locally any 
systemic effects should be reported immediately. 

Therapeutic Uses. — The therapeutic uses of atropine 
may be summarized as follows: 

1. By local applications to relieve pain and to dilate 
the pupil of the eye. 

2. To check secretions. 

3. To check spasms of involuntary muscles. 

4. To stimulate respiration. 

Administration. — The common preparations for local 
use are the liniment, ointment, and plaster of belladonna. 
Belladonna leaves are burned and the fumes inhaled 
for asthma. For systemic action atropine sulphate is 
used: (1) to stimulate the respiratory centre, dose 
gr. go (1 m g-); (2) to paralyze nerve endings, dose 
g r - ikrm (0.5-0.4 mg.). The maximum dose is 
g r - lk>~5b (1.2-3 mg.). A 1 per cent, solution is used 
in the eye. The preparations of belladonna given 
internally are as follows: the tincture (10 per cent.), 8 
minims (0.5 Cc); the fluidextract, 1-2 minims (0.06- 
0.1 Cc); and the extract, J grain (0.01 Gm.). 

Toxicology. — The early symptoms of overdoses of 
atropine are dryness of the throat and dilatation of the 



ACTION ON THE CENTRAL NERVOUS SYSTEM . 99 

pupil of the eye. There frequently occurs flushing 
of the face or eruptions of the skin. The central 
action causes first excitability, then delirium followed 
by paralysis. The mental symptoms of atropine 
poisoning are so slow to develop and so prolonged 
that they have led to diagnoses of insanity. For this 
reason belladonna used to be a favorite drug for 
poisoning with criminal intent. 

The early treatment is lavage with potassium per- 
manganate. Artificial respiration should be started 
as soon as any symptom of depression is detected. 
As the final stage of poisoning is depression, stimulants 
are indicated, the best of which is caffeine. 
Drugs Allied to Belladonna. — In the botanical family 
to which belladonna belongs there are other medicinal 
plants whose active principles are atropine or other 
alkaloids similar in action. These are hyoscyamus, 
scopola, and datura stramonium. The following 
outline shows their similarity: 

Crude drug. Alkaloid. 

atropine. 
Belladonna/ 

^hyoscyamine. 
Hyoscyamus^ 

(henbane) Scopolamine (hyoscine). 

Scopola scopolamine, 

atropine, 
hyoscy amine. 
Stramonium hyoscyamine. 
Active Principles. — Belladonna owes its activity to 
atropine and to hyoscyamine, which have practically 



100 DRUGS WHICH ACT ON NERVOUS SYSTEM 

the same actions. Hyoscyamus contains hyoscyamine 
and another alkaloid, scopolamine, which has the same 
peripheral action as atropine, but a more pronounced 
depressing action on the central nervous system. 
Scopolamine predominates and determines the action 
of hyoscyamus and also of scopola. When the alkaloid 
of scopola was isolated, it was named scopolamine 
from the name of the plant, and it has since been found 
that the alkaloid of hyoscyamus which was named 
hyoscine is identical with it. Stramonium owes its 
activity to hyoscyamine. 

Therapeutic Uses. — These drugs and their alkaloids 
all resemble atropine, but have come to have certain 
special uses. Hyoscyamus, because of the predominance 
of scopolamine, is used as a sedative for children and 
the insane and to relieve inflammatory conditions of 
the bladder. 

Scopolamine itself is an efficient sedative in insanity 
and alcoholic delirium. Patients should be carefully 
watched after its administration as it not infrequently 
causes severe depression and collapse. It has been 
and is still under much discussion as a preliminary 
to the anesthetic in surgery and for the production 
of the so-called "twilight sleep" in obstetrics. 

The complete development of a method of painless 
childbirth by this drug is the work of Dr. Kronig and 
his assistant, Dr. Gauss, at the Frauenklinik in the 
University of Baden at Freiburg, Germany. This 
method depends upon the power of scopolamine when 
properly given to cause a state of semiconsciousness 
in which the sense of pain is reduced and memory 



ACTION ON THE CENTRAL NERVOUS SYSTEM 101 

of it abolished, but the patient retains control of her 
muscles and ability to respond to requests. Factors 
absolutely essential to this kind of sleep are quiet, 
semidarkness, ceaseless watchfulness on the part of 
the muse and doctor, and tact in applying the tests 
of memory. The condition of the memory is the symp- 
tom by which the dosage of the drug is regulated. The 
first dose of scopolamine is combined with morphine 
and is usually given as soon as the pains are regular. 
After the first dose scopolamine in diminishing doses 
is as a rule given alone about every hour. 

Scopola has no place in medicine. Stramonium leaves, 
the only form of that drug used, are burned and the 
fumes inhaled to relax the muscular walls of the alveoli 
and bronchi in asthma. 

Dosage. — As the dose of hyoscyamus itself is larger 
than that of nux vomica and belladonna, the doses 
of the pharmaceutical preparations are correspondingly 
larger: the tincture (10 per cent.), dose Tfl.xxx (2 Cc); 
the fluidextract, dose Tfl,iij (0.2 Cc); and the extract, 
dose gr. j (60 mg.). The dose of scopolamine hydro- 
bromide is gr. T tt (0.5 mg.). 

Central Depressants. 

Morphine. — Description. — Morphine is the chief alka- 
loid of opium. Opium is the dried, milky juice from 
the capsules of the poppy plant. Although this 

drug is usually associated with China because of its 
extended use there for smoking, the supply for medicine 
comes from Asiatic Turkey. The cultivation of opium 



102 DRUGS WHICH ACT ON NERVOUS SYSTEM 

was an industry in that country before the time of 
Christ. All the early medical writers describe it. 
Probably the Arabs were responsible for its introduc- 
tion into Persia and thence to China where it became 
a national curse as "smoking dirt." The first edict 
in China against the cultivation and use of smoking 
opium was in 1796, but not until in very recent years 
have radical measures taken by the government and 
missionaries shown any appreciable results in removing 
the curse from the nation. The United States imposes 
a duty of $6 a pound on smoking opium but very 
large quantities are brought in by smugglers. It is 
estimated that 70,000 pounds a year would supply the 
demand for medicine, while 500,000 pounds annually 
come into the country. 

Action on Brain. — The action of morphine on the 
nervous system is confined chiefly to the central 
portion, and it is predominately that of depression. 
In small doses the effect on the brain is to dull its power 
of perception, especially of pain. If insomnia is present 
due to pain small doses of morphine are often sufficient 
to produce sleep if the external conditions are favorable. 
Large doses will compel sleep in spite of conditions. 
Toxic doses produce a stupor. Morphine surpasses 
all other drugs in its power to relieve pain and insomnia 
due to pain. Other medicines, less depressing and less 
liable to form a habit, are to be preferred in insomnia 
not due to pain. 

Action on Medulla. — Morphine also acts on the 
medulla, depressing the respiratory centre, slowing 
the heart, and stimulating the vomiting centre. 



PLATE I 




Papaver Somniferum — Opium Poppy. 

(Courtesy of Parke, Davis & Co.) 



ACTION ON THE CENTRAL NERVOUS SYSTEM 103 

Through its depression of the respiratory centre 
morphine relieves cough. It does not cure but simply 
alleviates symptoms. If there is profuse bronchial 
secretion with the cough its use is dangerous, for an 
accumulation of mucus in the lungs might cause 
suffocation. Morphine before anesthesia is not without 
some danger, as it renders the respiratory centre more 
susceptible, especially to chloroform. The slowing of 
the heart is due either to depression of the accelerator 
centre or stimulation of the vagus. This effect is 
sometimes desired in therapeutics for nervous con- 
ditions of the heart. The stimulation of the vomiting 
centre with resulting nausea and vomiting are dis- 
agreeable but seemingly unavoidable side actions of 
morphine with small doses. Larger ones depress the 
vomiting centre and check emesis. 

Action on Cord. — In animal experimentation it has 
been shown that morphine has a strychnine-like 
effect on the spinal cord. It is occasionally seen in 
children. While this action is overshadowed in adults 
it is nevertheless present and makes morphine unsuit- 
able as an antidote to strychnine. A still more 
important reason for not giving morphine in strychnine 
poisoning is its action on the respiratory centre, for 
death from strychnine is due to paralysis of that 
centre. 

Minor Actions. — There are three somewhat important 
minor actions of morphine, the mechanisms of which 
are not well understood. It causes the pupil of the eye 
to contract and this is a means of detecting overdoses. 
It dilates the bloodvessels of the skin and tends to 



104 DRUGS WHICH ACT ON NERVOUS SYSTEM 

start perspiration. Dover's Powder, a favorite mixture 
of opium and ipecac, is given for this action, but it 
is of little use unless accompanied by copious hot 
drinks. Whether given by mouth or subcutaneously 
morphine tends to check intestinal peristalsis. For 
this reason it is useful in peritonitis, diarrhea, and 
post-operative cases. In other cases this is a very 
annoying side action which is difficult to overcome. 
After morphine ordinary cathartics have little effect 
on the intestines. Morphine has no action on sensory 
nerve endings, and its application locally as dusting 
powder or in washes to relieve pain is irrational and 
useless. It seems in some way to decrease the excre- 
tion of sugar in diabetes and produces a general 
improvement in that disease. 

Therapeutic Uses.— The therapeutic uses of morphine 
may be summarized as follows: 

1 . As a brain depressant to relieve pain and insomnia 
due to pain. 

2. As a depressant of the medulla to relieve cough, 
quiet the heart, and check emesis. 

3. To induce sweating. 

4. To check peristalsis. 

5. In diabetes to lessen excretion of sugar. 

Untoward Actions. — The untoward actions of -mor- 
phine are nausea, vomiting, constipation, and the 
tendency to form habit. In a recent investigation in 
a large city of the South morphine headed the list of 
drugs used by habitues, cocaine came next, then other 
forms or derivatives of opium, mostly laudanum and 



ACTION ON THE CENTRAL NERVOUS SYSTEM 105 

heroin. Over 54 per cent, of the cases of drug habit 
were started by physicians' prescriptions. 

Other Alkaloids of Opium. — There have been isolated 
from opium eighteen other alkaloids besides morphine, 
two of which are of some importance— codeine and 
narcotine. They are present in relatively small quanti- 
ties. It was long believed that narcotine was the 
constituent of opium which was responsible for its 
nauseating effect, and for this reason opium deprived 
of this alkaloid, denarcotized or deodorized opium, was 
given preference. It is now known that this is not 
true. Codeine is obtained from opium or made syn- 
thetically from morphine. Codeine is less efficient 
than morphine to relieve pain and insomnia, but 
it is very good when only a mild action is desired. It 
is better for coughs because it is less depressing to the 
respiratory centre, less constipating, and less -liable 
to form habit. 

Heroin is a compound made from morphine by 
a chemical reaction between it and acetic acid. It 
resembles codeine in its action on coughs, but it is no 
better and should have no place in medicine because it 
is a dangerous habit-forming drug. Its use by habitues 
is favored by the fact that it is cheap and its dose is 
small, gr. 2V (3 mg.). 

Dosage. — Opium in the form of granulated opium 
contains about 12 per cent, of morphine. Therefore 
the dose of opium which is 1 grain (60 mg.) contains 
about gr. J (8 mg.) of morphine. Preparations of 
opium are preferred to morphine for action on the 
gastro-intestinal tract. 



106 DRUGS WHICH ACT ON NERVOUS SYSTEM 



Powdered opium, 


gr. j 


0.06 Gm. 


Extract of opium, 


gr. ss 


0.03 Gm, 


Tincture of opium (10 






percent.) (laudanum) , 


mviij 


0.5 Cc. 


Camphorated tincture 






of opium (paregoric), 


f 5ij 


8.0 Cc. 
phine gr. T \ (0 . 00 


Powder of ipecac and 






opium (Dover's pow- 






der), 


gr. viiss 


0.5 Gm, 


Morphine sulphate: 






1. To relieve pain, 


err ! i 


0.001-0.015 Gm. 


2. To relieve cough, 


S r - T6 


0.004 Gm 


Codeine sulphate, 


er.i 


0.03 Gm, 


Magendie's solution 


TUv 


0.03 Cc. 



= morphine sulphate gr. •§• (0.01 Gm.) 
(Solution of morphine sulphate 1: 30, 16 gr. to 1 ounce, or 1 to 30 Cc.) 

Toxicology. — The symptoms of morphine poisoning 
are what may be expected from its action on the 
central system, contracted pupils, flushed face, slow 
heart, deep, slow breathing, and stupor. As morphine 
is excreted largely into the alimentary canal, whether 
given by mouth or by hypodermic injection, one 
method of eliminating it is to give repeated lavage 
with water or potassium permanganate and irrigation 
of the colon. The best physiological antidote is caffeine, 
pure or in the form of black coffee. Coffee may be 
given by mouth or by rectum, caffeine also by hypo- 
dermic injection. Strychnine and atropine should be 
avoided. Artificial respiration is most useful. The 
patient must be kept warm as the temperature usually 
falls as a result of the great depression. All efforts 
must be made to keep the patient awake. 

Opium Habit. — The first bad effects from the opium 
or morphine habit are in the alimentary canal. At 
one time there will be chronic constipation, later chronic 
diarrhea; there may be for a while loss of appetite 



ACTION ON THE CENTRAL NERVOUS SYSTEM 107 

followed by a voracious appetite. A person may take 
these drugs for years without showing symptoms 
noticeable to an ordinary observer. The pupils are 
contracted, the eyes dull, and the face after a time has a 
peculiar pallor. There are various nervous symptoms 
such as irritability, heightened reflexes and an irregular 
heart. Sooner or later the habitue loses flesh and 
develops low moral habits. A characteristic of this 
drug habit is a seeming lack of power to tell the truth. 
The habitue makes promises conscientiously, but does 
not and cannot keep them. The highest duties may 
make some appeal to him, but he has not the power 
to perform them. When a person reaches this stage 
he should be treated not as innately evil but as pitiably 
ill. A nurse must remember that such a patient is 
never to be trusted and will resort to all kinds of tricks 
to secure his drug. It is practically impossible to cure 
a morphine or opium habitue except in a special in- 
stitution where he is totally removed from friends and 
hirelings. He may want to be cured but lacks the 
will-power to endure the suffering. The nurse, doctor, 
relative, or friend must supply that power by kind 
but firm guidance. 

Alcohol. — Alcohol is the name of a class of organic 
compounds which contain the radical — OH, and in this 
respect may be compared with the inorganic hydroxides. 
The rest of the compound is composed of other radicals 
which are derived from hydrocarbons. 

Hydrocarbon Series. — Hydrocarbons are compounds 
of hydrogen and carbon. Methane, CH 4 and benzene, 
C 6 H 6 , are examples. They exist in a number of series, 



108 DRUGS WHICH ACT ON NERVOUS SYSTEM 

each series being named from its simplest member. 
The two series from which important medicines are 
derived run as follows: 

Methane Series. Benzene Series. 

CH4 = methane. CeH6 = benzene. 

C2H6 = ethane. C7H8 = toluene. 

C3H8 = propane CgHio = xylene. 
C4H10 = butane. — — — 

C5H12 = pentane. — — — 



Ci 2 H, 



C60H1 



Hydrocarbon Derivatives. — From the methane series 
are derived the alcohols, and from the alcohols two 
other classes of compounds important in medicine, 
the ethers formed by dehydration and the aldehydes 
by direct oxidation. For example, by dehydrating 
methyl alcohol methyl ether is obtained; by oxidizing 
it formaldehyde is formed. From the benzene series 
most coal-tar products are obtained (see page 128). 
These numerous substances are all formed from the 
hydrocarbons by the substitution of some element 
or radical for one or more hydrogen atoms. For 
example the substitution of three atoms of chlorine 
for three atoms of hydrogen in methane forms chloro- 
form, CHCI3. 

Radicals. — When one or more hydrogen atoms are 
thus displaced what is left of the original hydrocarbon 
is called the radical. Those given below remain after 
the displacement of one hydrogen atom. The names 
of the radicals are derived from the corresponding 
hydrocarbons and have characteristic endings. 



ACTION ON THE CENTRAL NERVOUS SYSTEM 109 



Hydrocarbon. 




Radical. 


CH4 = methane. 
C2H6 = ethane. 
C5H12 = pentane. 


CH 3 
C2H5 
C5H11 


= methyZ radical, 
= ethyl radical. 
= amyl radical. 



Alcohols. — Alcohols are compounds in which the 
hydrogen has been displaced by one or more — OH 
radicals, and are distinguished by the names of the 
hydrocarbon radicals which they contain. 



CH4 


= methane. 


CH3OH 


= methyl alcohol. 


C2H6 


= ethane. 


C2H5OH 


= ethyl alcohol. 


C5H12 


= pentane. 


CsHuOH 


= amyl alcohol. 



Methyl Alcohol.— Methyl alcohol (CH 3 OH) is popu- 
larly called wood alcohol because it is obtained in 
commerce by the distillation of oak wood. Other 
trade names are Colonial and Columbian Spirits. 
Methyl alcohol is one of the most dangerous poisons. 
The use of it externally, internally, or the breathing 
of its fumes for a continued period causes permanent 
blindness by destruction of the optic nerve. Poisoning 
by methyl alcohol occurs largely as a result of the use of 
alcoholic beverages, popular medicines, and toilet 
waters which have been adulterated with it. It has 
exactly the same appearance and about the same odor 
as ethyl or grain alcohol which is used in medical 
practice. Attempts are being made to change the 
name to "wood spirit." Educational campaigns are 
in progress to spread a knowledge of its dangers and 
stringent laws are being passed to restrict its sale. 
At the time that the dangers of wood alcohol were first 
discovered, ethyl or grain alcohol was very expensive 
on account of an internal revenue tax imposed by the 



110 DRUGS WHICH ACT ON NERVOUS SYSTEM 

Government. This tax was removed in 1906 from all 
alcohol to be used in the industries, provided it was 
denatured, that is, mixed with other substances which 
make it unfit for medicinal use. In denatured alcohol to 
every 100 parts of ethyl alcohol there are 10 parts of 
methyl alcohol and 0.5 of benzine or other chemical 
added to make the mixture nauseating. 

Ethyl Alcohol.— Source.— Ethyl alcohol (C 2 H 5 OH) is 
popularly called grain alcohol because it used to be 
made by fermentation of grain. Now potatoes, rice, 
and other substances containing large amounts of 
sugar and starch are used in its manufacture. Other 
trade names are Rectified Spirit (95 per cent.), Proof 
Spirit (50 per cent.), and High Wine. Alcohol in 
the form commonly used in hospitals is 95 per cent, 
in strength; dilute alcohol is 49 per cent. Absolute 
alcohol, 99 per cent., has to be made by special pro- 
cesses and is not in common use. 

Preparations of Alcohol. — Ethyl alcohol is used exter- 
nally pure or diluted with water but internally in the 
form of various alcoholic preparations. The compara- 
tive strength of the more common ones is shown below. 



50 per cent. 



Aromatic spirit of ammonia, 70 per cent. 

Gin, 60-70 per cent. 

Whisky (spiritus frumenti) 

Brandy (spiritus vini galli) 

Elixirs, 25-35 per cent. 

Wines, 15 per cent. 

Beers 

Ale \ 7 per cent. 

Stout 



Some of these preparations owe part of their activity 
to other constituents than the alcohol, The malted 



ACTION ON THE CENTRAL NERVOUS SYSTEM 111 

beverages, such as beers, contain hops which are 
slightly hypnotic; brandy and red wines contain 
small amounts of tannic acid which exerts an astringent 
action on the intestines. Gin contains the volatile 
oil of juniper, an irritant to the kidneys, which is 
responsible for its diuretic action. Effervescing wines, 
such as champagne, owe much of their effect to the 
carbon dioxide which is a stimulant to mucous mem- 
branes. The ammonia in aromatic spirit of ammonia 
is itself a stimulant. 

Local Action.— The action of alcohol when applied 
locally to the skin and mucous membranes is quite 
different from its effect after absorption. When 
applied to the skin it removes water from the epithelial 
cells and coagulates their albumin. If the alcohol 
is dilute the result is a mild stimulation, if it is strong, 
an antiseptic and astringent action. Therefore bathing 
with alcohol may be useful to stimulate the skin or 
to harden it according to the strength of the solution 
used. 

Local Use. — The local stimulation of alcohol on the 
walls of the stomach improves digestion, increases 
the secretions and muscular movements, improves the 
appetite, and hastens the absorption of foods and 
medicines. For this purpose preparations not over 
15 per cent, in strength must be used, for stronger 
solutions check ferment action. Wines and beers 
are the forms used as, gastric stimulants. The astrin- 
gent action of alcohol, in the form of brandy, is useful 
in diarrhea. If the antiseptic action of alcohol is 
desired in gargles or as a preservative it should be 



112 DRUGS WHICH ACT ON NERVOUS SYSTEM 

used in about 60 per cent, solutions, as' stronger ones 
coat the outside tissues with a film of hard albumin 
and prevent further penetration. 

Systemic Action.— Before Absorption. — Besides the 
effect at the point of application strong alcohol, when 
locally applied to mucous membranes or to subcu- 
taneous tissues by injection, has a marked and prompt 



After absorption 



Before absorption 




Respiration, 
stimulated. 



Fig. G. — Diagram of action of alcohol. 



reflex action on the central nervous system. There 
results an increase in the rate of the heart and respira- 
tion and a general feeling of warmth due to dilatation 
of the cutaneous bloodvessels (see Fig. 6). In this 
way alcohol gives very prompt results in fainting, 
collapse, and emotional shock. It is usually given in 
such cases in the form of brandy or whisky by mouth 



ACTION ON THE CENTRAL NERVOUS SYSTEM 113 

or intramuscularly. Because of the tendency to produce 
a fall in blood-pressure later, other stimulants are 
preferred in severe surgical or traumatic shocks. 

After Absorption. — When alcohol is absorbed it acts 
on the central nervous system probably almost wholly 
as a depressant. The familiar preliminary stage of 
excitement seen in these who indulge in liquors may 
be due to a brief stimulation of certain centres, such 
as those which control the function of speech, or to a 
depression of the centres of self-control. As a 
depressant, alcohol is used in medicine in insomnia and 
mild shock and to relieve nervousness and anxiety 
in fevers and heart disease. The use of alcohol as a 
stimulant in cases of poisoning and in prolonged illness 
is very much limited, if not contra-indicated, on 
account of its later depressing effect, 

A Food. — Alcohol as a food has been a much-dis- 
cussed question. It seems now agreed that a certain 
small amount is oxidized and the resulting energy 
and heat are used by the body in its normal processes. 
Alcohol, therefore, not in excess of the amount that 
can be oxidized, is useful in that it spares the fat and 
carbohydrate portions of ingested foods. 

Phenol Antidote. — Alcohol is the most efficient 
antidote for phenol. For method of administration 
in cases of poisoning, see page 67. Phenol is more 
soluble in alcohol than in the tissue fluids and if it is 
removed quickly the tissues are restored to normal. 

Therapeutic Uses. — The important uses of alcohol 
may be summarized as follows: (1) as an antiseptic 
(not over 60 per cent.) ; (2) as a stimulant or astringent 
8 



114 DRUGS WHICH ACT ON NERVOUS SYSTEM 

on the skin according to the strength used; (3) as a 
quick reflex stimulant in crises and emotional shock; 
(4) as an antidote to phenol. Minor uses are (1) as a 
stimulant to digestion and absorption; (2) as a nerve 
sedative; (3) as a food. 

Disadvantages. — The disadvantages of the use of 
alcohol even in moderate amounts may be stated 
briefly as follows: (1) its tendency to form habit; 
(2) a decrease of mental efficiency; (3) a possibility 
of a serious fall of temperature, if taken before expo- 
sure to cold; (4) a predisposition to infection; (5) a 
decrease in muscular endurance. This seems sufficient 
argument against the use of alcohol as a beverage 
or as a medicine except in emergencies. Strong coffee 
is the best antidote to overdoses of alcohol in any form. 

Movements against Use of Alcohol.— There are 
strong forces at work in the world today combating 
the use of alcohol as a beverage. The various prohibi- 
tion societies are attacking the problem from a moral 
point of view; great corporations like the railways, 
the employees of which control human life, on the 
basis of inefficiency are not employing users of alcohol; 
the great nations of the world are enforcing prohibition 
in their armies and navies as a means of securing the 
highest degree of muscular endurance as well as of 
efficiency. In the United States the internal revenue 
office is endeavoring to check the use of medicated 
alcoholic preparations as beverages by levying a tax 
on their manufacture and sale. Any preparation, even 
if sold as a medicine, is subject to tax unless "it is 
sufficiently medicated to render it unfit for use as a 



ACTION ON THE CENTRAL NERVOUS SYSTEM 115 

beverage." A recent list (June, 1914) contains 287 
medicinal preparations subject to tax and includes all 
kinds of stomach bitters, tonics, cordials, and elixirs. 



Morphine 
Alcohol 
(after absorption) 



Jlorphine 
Alcohol 
Atropine 
(toxic doses) 



Strychnine 
(toxic doses between 
convulsions) 




Caffeine 
Camphor 



Caffeine 
Camphor 
Atropine 
Strychnine 



Strychnine 
Morphine 



Fig. 7. — Comparative action of the central stimulants and depressants 



These lists can be obtained from the Treasury Depart- 
ment at Washington, D. C. Evidence of the evils 
attending the use of this drug may be found in the 



116 DRUGS WHICH ACT ON NERVOUS SYSTEM 

reports of institutions for the insane, the defective, 
the deformed, the epileptic, and the criminal. These 
show that the condition of a large percentage of the 
inmates is due to excessive use of alcohol either by 
themselves or their parents. 

Hypnotics. 

Hypnotics. — Hypnotics are medicines given to pro- 
duce a condition resembling natural sleep. They are 
also called somnifacients and soporifics. These medi- 
cines, almost more than any others, should be used 
only as a last resort, for no hypnotic is known which is 
absolutely safe and which does not tend to produce a 
habit. 

Action. — They produce sleep by directly depressing 
the brain centres. A therapeutic dose is one which 
depresses them just enough to cause a natural sleep. 
If this dose is exceeded the sleep passes to a stupor, 
the heart and respiration are depressed, and a con- 
dition results called narcosis. Narcosis is never sought 
in therapeutics but is a result of overdosing. The 
action of a hypnotic is much more effective if the 
patient is in a quiet state before its administration. 
To induce this state the nurse should make all external 
conditions favorable to sleep; place a hot-water bag 
at the patient's feet, give a light massage to reduce 
the blood supply of the brain, and relieve the patient's 
mind of worry and distracting thought. 

Morphine. — Morphine, which has already been 
studied, is the great hypnotic of medicine, and is 



ACTION ON THE CENTRAL NERVOUS SYSTEM 117 

practically the only one which will act in the presence 
of severe pain. Too much emphasis cannot be laid on 
the fact that morphine is a dangerous habit-forming 
drug. If wisely used it is one of mankind's greatest 
blessings; in careless hands it is a terrible curse. If 
insomnia is due to other causes than pain, such as 
nervousness or excitement, other hypnotics are always 
to be preferred. 

Chemical Hypnotics. — These other hypnotics are 
chemical compounds which owe their activity to some 
one constituent. They may be classified as follows: 

1. Those whose activity is due to a halogen: hj^drated chloral, 
bromides. 

2. Those whose activity is due to an ethyl radical: trional, sul 
phonal, tetronal. 

3. Those whose activity is due to an aldehyde: paraldehyde. 

Hydrated Chloral. ■ — Hydrated chloral (C 2 HC1 3 
+H 2 0) is a white crystalline substance which on 
exposure to light and air changes to chloral, a highly 
toxic compound. For this reason it must be kept in 
well-stoppered amber-colored bottles. As a hypnotic 
it acts quickly, usually in less than an hour, and its 
effects are fairly lasting. Hydrated chloral has the 
reputation of being more dangerous than other 
hypnotics, but in ordinary doses it is relatively safe. 
In large doses it is distinctly dangerous, because it 
directly depresses the heart muscle and causes alarming 
heart symptoms. For this reason in cases of poisoning 
by chloral the patient must be kept absolutely quiet 
to prevent any strain on the heart. Somnos, somnal 
and bromidia are proprietary remedies which owe their 
activity to hydrated chloral. 



118 DRUGS WHICH ACT ON NERVOUS SYSTEM 

Bromides. — There are seven official bromides, the 
most important being sodium and potassium bromides. 
There is a common preparation called triple bromide 
which contains these two and ammonium bromide. 
Dilute hydrobromic acid has the same action. The 
bromides are all white or colorless salts with a bitter 
or salty taste. Their chief use is as nerve sedatives, 
but in insomnia not due to pain they are useful as 
hypnotics. In the presence of pain such large doses 
are required to produce sleep that they also depress 
the heart and respiration and under those conditions 
may be unsafe. 

Ethyl Hypnotics. — In this group are sulphonal, 
trional, tetronal, veronal and medinal. To a large 
extent these hypnotics are alike in their degree of 
action. The similarity of their composition is shown 
in the graphic formulae of the first three. 

CH 3 S0 2 C 2 H 5 C 2 H 5 SO2C2H5 C 2 H 5 S0 2 C 2 H 5 



CH 3 S0 2 C 2 H 5 CH 3 S0 2 C 2 H 5 C 2 H 5 S0 2 C 2 H 5 

Sulphonal. Trional. Tetronal. 

Veronal is an ethyl hypnotic of complex composi- 
tion derived from urea. Medinal is a sodium salt 
of veronal, the purpose of the combination being to 
obtain a more soluble compound. Sulphonal is official 
in the greatest number of pharmacopeias. The ethyl 
hypnotics are slow in action, requiring about two 
hours to produce sleep. The prolonged use of them is 
highly dangerous as they may suddenly cause collapse 
which in about 50 per cent, of the cases is fatal. If 



ACTION ON THE CENTRAL NERVOUS SYSTEM 119 

sulphonal is being used continuously the urine should 
be examined frequently for hematoporphyrin, one of 
the decomposition products of red blood corpuscles. 
Its presence is a positive warning of danger. 

Paraldehyde. — Paraldehyde is a colorless liquid with 
a pungent, disagreeable odor and taste which very 
much limits its usefulness. It acts in about thirty 
minutes and in most cases is efficient. 

Administration. — Hydrated chloral: gr. v-xx (0.3-1.3 
Gm.). Bromides: as nerve sedatives, gr. xx (1 Gm.); 
as hypnotics up to gr. xxx (2 Gm.). Sulphonal, trional, 
and tetronal, gr. xv (1 Gm.); veronal and medinal, gr. v 
(0.3 Gm.). Paraldehyde: lUxxx (2 Cc). 

Hydrated chloral and the bromides are irritating 
to the stomach and should be given well diluted in 
water or milk. Hydrated chloral may be given on 
cracked ice. Paraldehyde should be given in ice- 
water or on cracked ice or with some aromatic to dis- 
guise the taste. 

It is easier to induce a person to sleep at his normal 
time for retiring, and hypnotics are best given so that 
they will act at that time. For example, if it requires 
two hours for one to act, it should be given two hours 
before the patient is expected to sleep. 

Some people are very susceptible to the action of the 
bromides and suffer from headaches, skin eruptions, 
and cyanosis after their administration. These symp- 
toms would indicate a reduction in the dose or the 
discontinuance of the drug. If some hypnotic must 
be used over a long period the danger of habit formation 
may be obviated by using different drugs for a short 
time. 



120 DRUGS WHICH ACT ON NERVOUS SYSTEM 

Toxicology. — For poisoning by morphine, see page 
106. If poisoning by the other hypnotics is discovered 
early remove them at once from the stomach by lavage. 
If depression has already set in, give cathartics and use 
general measures of stimulation with caffeine as the 
physiological antidote. Keep the patient very quiet, 
as any exertion on his part may cause heart failure. 

General Anesthetics. 

Definition.— An anesthetic is a drug given to produce 
immobility and insensibility. A general anesthetic 
causes this condition over the whole body usually with 
loss of consciousness; a local one produces it in some 
limited area at the point of application. 

History. — In ancient times the Egyptians, Hindus, 
and Chinese used for anesthesia some narcotic drug 
which was given by mouth. In the middle ages opium 
and hyoscyamus were tried and often alcoholic liquors 
were given until the patient was in a stupor. Ethyl 
ether, which is in such common use at the present 
time by inhalation, was known as a chemical com- 
pound 300 years before its use as an anesthetic. About 
100 years ago the inhalation of ether was a fad and 
ether parties were in vogue. In 1842 a doctor in 
Georgia, Crawford Long, at one of these parties 
noticed that while under the influence of the drug 
sensibility to pain was much decreased. He com- 
menced using it in his medical practice but did not 
spread the knowledge of his discovery. In 1846 Dr. 
Morton, of Harvard Medical School in Boston, popular- 



ACTION ON THE CENTRAL NERYOVS SYSTEM 121 

ized its use in surgical operations and he is generally 
accredited with the discovery of its anesthetic action. 
Chloroform was discovered as an anesthetic the next 
year and nitrous oxide shortly afterward. These 
three compounds and ethyl chloride are the general 
anesthetics now in common use. 

Description. — Ethyl ether is one of the class of com- 
pounds called ethers which are made from alcohols 
by dehydration. 

C 2 H 5 OH 

-> (C 2 H 5 ) 2 + H2O 
C2H5OH 
Ethyl alcohol. Ethyl ether. 

Ethyl ether is sometimes spoken of as sulphuric 
ether because sulphuric acid is the dehydrating agent 
used in its manufacture. It is highly inflammable. In 
chemical nomenclature chloroform is trichlor-methane, 
the name indicating its composition. 

CH 4 + 3C1 -> CHCI3 +3H 
Methane. Chlorine. Chloroform. 

Nitrous oxide (N 2 0) is a gas popularly called "laugh- 
ing gas/' used very generally by dentists for the 
extraction of teeth. This gas combined with oxygen is 
now employed almost exclusively as an anesthetic 
in some hospitals. A special apparatus is used by which 
the two gases are mixed and the proportion varied as 
desired. 

The composition of ethyl chloride (C 2 H 5 C1) is indicated 
by its name. It is a colorless inflammable liquid which 
easily vaporizes. For general anesthesia the vapor 



122 DRUGS WHICH ACT ON NERVOUS SYSTEM 

is conducted into an inhaler. For local use it is kept 
in glass tubes which have a minute opening at one end 
covered by a metallic cap. When the cap is removed 
the liquid escapes in a fine spray. If one of these 
tubes is held for some time in the hand, the heat of the 
hand is sufficient to vaporize the liquid inside and 
burst the tube. Nitrous oxide, chloroform, and ethyl 
chloride produce anesthesia very promptly, in from 
2-5 minutes; ether requires from 8-15 minutes. 

The Anesthetist. — The administration of anesthetics 
is now recognized as an art and doctors and nUrses 
are specializing in this work. Not only is skill required 
in the actual anesthetization but in the choice of the 
anesthetic, for age, temperament, habits of sobriety, 
the condition of the heart, lungs, and kidneys are all 
factors which must be considered in its selection. 
The legal status of nurse anesthetists is still under 
discussion. There is at present no law prohibiting 
others than registered physicians from giving an 
anesthetic, but it has been contended by certain courts 
that this act constitutes practice of medicine, hence 
would be illegal if performed by a nurse. 

Methods of Administration. — For a number of years 
the only method of general anesthesia was by direct 
inhalation of ether or chloroform. There are so many 
disagreeable side actions and after-effects from these 
that in recent years attempts have been made to devise 
other methods. Various mixtures of ether, chloroform, 
and alcohol by inhalation have been tried. Ether and 
chloroform have been given intravenously, ether 
vapor given by a tube inserted into the trachea (intra- 



ACTION ON THE CENTRAL NERVOUS SYSTEM 123 

tracheal insufflation) and by rectal injection, cocaine 
and stovaine by injection into the spinal canal, mor- 
phine and scopolamine by subcutaneous injection. 
Some one of these methods of anesthesia may be popu- 
lar in certain hospitals, but no one has as yet been 
so successful as to gain general favor. 

Stages of Anesthesia. — There are four stages in 
anesthesia by the inhalation of ether and chloroform, 
three of them practically always seen, the fourth a 
danger stage always to be avoided. 

First Stage. — The first stage is one of local irritation. 
Ether and chloroform are both highly irritating to 
mucous membranes, and chloroform is liable to burn 
the skin if in full strength or in a concentrated vapor. 
This action causes most annoying conditions as cough- 
ing, choking, weeping of the eyes, and an increased 
flow of saliva. 

Second Stage. — The second stage is characterized 
by excitement. It is practically eliminated by chloro- 
form, the full effect of this anesthetic being reached so 
quickly. The excitement is probably due to an early 
paralysis of the centres of self-control. It is during 
these two stages that death sometimes occurs, especially 
with chloroform, for in a desire to pass them over as 
soon as possible the anesthetic is given very strong and 
the concentrated vapor in the blood paralyzes the 
heart. 

Third Stage. — The third stage is called the stage of 
surgical anesthesia. Sensation, mobility, consciousness, 
and the reflexes, except one, are lost by a paralysis of 
the brain centres. The reflex of the cornea of the eye 



124 DRUGS WHICH ACT ON NERVOUS SYSTEM 

is the last to be affected, and should be retained during 
this stage. The failure of the cornea to respond to 
the touch is a sure sign of danger. The centres in the 
medulla are also depressed to a certain extent, so that 
the respiration and pulse are slow and full. The pupil 
of the eye is contracted. 

Fourth Stage. — The fourth stage is the result of an 
overdose of the anesthetic. The centres of the medulla 
are so greatly depressed that the respiration and pulse 
are irregular, the reflex of the cornea is lost, and the 
pupil dilated. In recovery from an anesthetic a patient 
passes through these same stages in a reverse order. 

After-effects. — While the muscles of the neck and 
throat are relaxed during anesthesia saliva passes 
down the esophagus into the stomach. This is satu- 
rated with ether vapor which irritates the stomach and 
causes postoperative vomiting. Another distressing 
after-effect is an abnormal formation and accumulation 
of gas in the intestines. There are various disorders 
of the respiratory tract following anesthesia, the 
chief one being "ether pneumonia." This may be due 
to an irritation of the lungs by the anesthetic or to 
the inhalation from the mouth of some germ which 
gains a foothold while the lungs are in a condition of 
lowered resistance. An acute nephritis, degeneration 
of some of the organs and paralysis of the stomach and 
intestines are other serious after-effects which may 
occur several days after anesthesia. 

Preparation of Patient. — There are a few routine 
essentials in the preparation of a patient for anesthesia 
which apply to all cases. The patient must be clean, the 



ACTION ON THE CENTRAL NERVOUS SYSTEM 125 

hair tightly covered and, in case of a woman, tightly 
braided, the alimentary canal and bladder must be 
empty and all removable articles, such as jewelry and 
false teeth, taken away. The kind of clothing and exact 
method of procedure in emptying the alimentary canal 
vary in different hospitals. It must be remembered that 



Danger Stage 



Surgical 
Anesthesia 



1. Consciousness lost 



i. Vital centres I * Ve - 
paralyzecl Vlullai 



3. Reflex oj 
cornea lost 



2. Reflexes lost except 
in cornea of eye 



Fig. 8. — Diagram of important factors in anesthesia. Number! 
indicate the order in which the effects appear. 



it requires strength to endure the ordeal of an operation, 
and a patient should not be weakened unnecessarily 
by being deprived of food too long before anesthesia. 
A calm state of mind before an operation has been 
shown to be an important factor in lessening shock. 
A nurse can do much to reassure her patient and 
frequently sedative drugs are given shortly before 



126 DRUGS WHICH ACT ON NERVOUS SYSTEM 

anesthesia. Morphine sulphate is the most commonly 
used; morphine and scopolamine or chloretone, a 
central depressant, may be used. Atropine sulphate 
is frequently given with morphine, the purpose of 
which is to lessen the secretion of saliva, to stimulate 
the respiration, and to prevent excessive stimulation 
of the vagus. It has been learned very recently that 
nearly every anesthesia causes acidosis, a condition 
in which acetone and various acids are present in the 
blood and urine. As preventive measures for this 
condition carbohydrates, such as sugar or a light, well- 
sweetened meal, are given about four or five hours 
before anesthesia, and a rectal injection of sodium 
bicarbonate one-half hour before. 

Comparison of Ether and Chloroform. — The immediate 
dangers of ether are much less than of chloroform, 
but if statistics were collected showing deaths by 
after-effects it is a question which would have the 
advantage. There are many fatalities from the effect 
of ether on the respiratory tract and kidneys. Chloro- 
form, on the other hand, is very depressing to the 
heart during its administration and tends to cause 
fatty degeneration of the liver and heart some days 
later. The preliminary and postoperative discomforts 
are much less with chloroform than with ether. Ether 
is highly inflammable, chloroform is not. The margin 
of safety during a prolonged anesthesia is greater with 
ether, while chloroform is to be preferred for examina- 
tions and short operations. Resuscitation from ether 
poisoning is quite frequent, even when the heart has 
stopped beating; resuscitation from chloroform is 
infrequent. 



ACTION ON THE CENTRAL NERVOUS SYSTEM 127 

Comparison of Ether and Nitrous Oxide. — Nitrous 
oxide administered with oxygen practically eliminates 
the discomforts of the first stage under ether and causes 
very much less postoperative nausea. The margin 
of safety under the mixed gases is much greater than 
with ether. Nitrous oxide is very quickly eliminated 
and is followed by practically none of the later compli- 
cations seen after ether. Its chief danger in long anes- 
thetizations is from asphyxiation but when properly 
given this is not considerable. 

Dr. Crile of Cleveland, Ohio, who has won fame by 
the results of his studies of shock and the performance 
of shockless operations, prefers nitrous oxide and 
oxygen to ether as an anesthetic in the belief that 
nitrous oxide tends to check brain activity while ether 
does not. He believes that excessive activity of the 
brain cells caused by floods of stimuli from the seat of 
the operation leads to their exhaustion and that this 
causes shock. 

Analgesics. 

Analgesics are drugs given for the purpose of pre- 
venting or reducing pain. 

Morphine, Codeine, Hyoscyamus. — Morphine sul- 
phate stands above all other drugs as an analgesic. 
It is given in doses of gr. |~i (0.008-0.015 Gm.) 
according to the intensity of the pain. Habit formation 
is its greatest danger, especially with patients of a 
nervous temperament. Codeine sulphate gr. J (0.03 
Gm.) is a good substitute when only a mild action 
is needed. Hyoscyamus in the form of a tincture is 



128 DRUGS WHICH ACT ON NERVOUS SYSTEM 



Refined 



^3 



Dq k 






8 c 



1^ 






^ 5 



5U «2 



C H 






*s 



ACTION ON THE CENTRAL NERVOUS SYSTEM 129 

frequently used with children or in mild treatment for 
adults. The adult dose is 30 minims (2 Cc). 

Coal-tar Analgesics. — The coal-tar products, acetan- 
ilid, antipyrine and phenacetine, constitute a group 
of remedies for the relief of minor pains and especially 
headaches. These are called coal-tar products because 
they are made from coal tar (see Fig. 9) . They really 
are by-products from the manufacture of coal-tar dyes. 

Action. — These remedies are all powerful central 
depressants which show their effect chiefly by quieting 
neuralgic pains and slowing the heart. "When they 
were first discovered about thirty years ago they 
were used exclusively to reduce temperature in fevers. 
With better knowledge of the nature of fever this 
action was recognized as undesirable in many cases. 
Their use was then restricted to quieting headaches 
and other nervous conditions, but so many bad results 
have been reported, such as cyanosis, depression and 
failure of the heart and formation of the drug habit, 
that doctors are prescribing them less and less for 
any purpose. 

Therapeutic Uses. — The chief uses of the coal-tar 
analgesics in therapeutics are as follows: 

1. As antipyretics to reduce temperature in certain 
types of fever (page 214). 

2. As analgesics to allay pain, chiefly headache and 
neuralgic pains. 

Proprietary Preparations. — Patent medicine manu- 
facturers have spread the use of these drugs widely 
by advertising mixtures of them under trade names 
for headaches, colds, grippe and about every pain 
9 



130 DRUGS WHICH ACT ON NERVOUS SYSTEM 

known to man. Shortly after the passage of the 
Food and • Drugs Act the United States Depart- 
ment of Agriculture suspected that many of these 
mixtures were not being properly labelled, and made 
an investigation of the extent of their sale, use, and 
dangers. 1 Since that time the American Medical 
Association has carried on extensive investigations 
and the results are appalling, both in the great number 
of proprietary preparations of these dangerous drugs 
and in the clever advertising to conceal their exact 
nature and to attract unsuspecting sufferers. 2 
Antikamnia, a popular headache remedy, contains in 
every ninety-eight parts, sixty-eight parts of acetanilid. 
Orangeine contains more than half acetanilid, phenalgin 
still a greater proportion. Hick's Capudine depends 
upon antipyrine and salicylates for its activity. Still 
these are all advertised as safe, without "dope," and 
in some cases to be taken freely. 

Habit Formation. — In the investigation by the 
United States Department of Agriculture 400 physicians 
reported 814 cases of poisoning, 29 deaths and 136 
cases of habitual use of these drugs, and in a large 
majority the remedy was taken for headache. In 
regard to habit formation, the following conclusion is 
given in the bulletin: "The ache or pain for which 
the medicine was first taken is often worse than ever 
after the effects of the remedy have passed away, 



1 The results of this investigation were published in Farmer's 
Bulletin, 377, The Harmfulness of Headache Mixtures. 

2 The book, Propaganda for Reform in Proprietary Medicine, pub- 
lished by the American Medical Association exposes these and many 
other frauds in medicine. 



ACTION ON THE CENTRAL NERVOUS SYSTEM 131 

because of the weakened condition of the system which 
may result from the use of these agents, and hence 
there is additional call for the remedy. Thus a habit 
may be established — more drug, impaired bodily 
health, lessened resistance, more pain, more drug." 

Comparative Effects. — Acetanilid and antipyrine are 
considered more dangerous than phenacetine, but the 
latter is by no means safe as 17 of the reported cases 
of habit formation were from that drug. Aspirin is a 
coal-tar derivative (see Fig. 9), which was supposed 
for a long time to be a safe substitute for the coal-tar 
remedies described above. Recently reported cases of 
poisoning have been on the increase and it, too, seems 
to be not without danger. Pyramidon is a still newer 
compound which is closely related chemically to 
antipyrine. It is claimed to have a more lasting 
analgesic effect and to be harmless to- the heart. All 
coal-tar analgesics are as safe in small doses as any 
powerful depressant but they should be used with a 
full knowledge of their dangerous character. 

Administration. — In headaches if a small dose of one 

of this group of drugs is not effectual, it is a fairly 

good indication that some other kind of medicine is 

needed for that type of headache. Repeated and 

increased doses to obtain a result are useless and 

unsafe. The average doses are as follows: 

Acetanilid, gr. iij (0.2 Gm.) 

Phenacetine, gr. viiss (0.5 Gm.) 

Antipyrine, gr. iv (0.25 Gm.) 

Aspirin, gr. v-xv (0.3-1 Gm.) 



132 DRUGS WHICH ACT ON NERVOUS SYSTEM 

Attempts are made to offset the untoward effects 
of these drugs by giving others in combination with 
them. Theoretically caffeine would offset their de- 
pressant action on the heart, and for this reason it 
is combined with acetanilid in Compound Acetanilid 
Powder (U. S. P.), a headache remedy. Recent studies 
have shown that caffeine tends to increase rather 
than decrease the toxicity of acetanilid, and many 
fatalities have been reported from the use of this 
powder. Sodium bicarbonate does seem to lessen 
the toxic effect of the coal tars on the heart. Strychnine 
is sometimes given to counteract the general depression 
and atropine to control any excessive sweating which 
may result. 

Toxicology. — Besides excessive sweating some people 
suffer from eruptions after administration of these 
drugs. The characteristic symptom of overdosing 
is cyanosis. In small doses this may be noticed only 
on the lips or under the nails. In large doses it may 
be apparent all over the body. It is due partly to the 
depressed heart action and partly to an alteration 
of hemoglobin in the red blood corpuscles. In severe 
cases and in chronic poisoning the corpuscles are them- 
selves destroyed and anemia results. Other symptoms 
of poisoning by large doses are burning of the whole 
alimentary canal, coldness of the extremities, various 
nervous symptoms, and collapse. Demulcents and 
general stimulation are indicated in treatment of 
poisoning. 



ACTION ON THE PERIPHERY 133 



ACTION ON THE PERIPHERY. 

Local Anesthetics. 

Local anesthetics, as already stated, are medicines 
which produce anesthesia at the point of application. 
The most important local anesthetic is cocaine. 

Cocaine. — Cocaine is an alkaloid derived from the 
leaves of erythroxylon coca, a small plant which grows 
on the slopes of high mountains in Peru, Ecuador 
and Bolivia. The history of coca is the history of 
Peru, as the ancient peoples considered it the living 
representative of their deity and the ground where 
it grew sacred. The natives of those countries at 
the present day make a practice of chewing coca 
leaves daily to give them strength and the power to 
endure hunger and fatigue. The results are wonderful 
but for some reason in other climates they cannot be 
secured. There must be some constituent of the 
leaves unknown to science which produces these 
effects, for the native chewers carefully select leaves 
which are not rich in cocaine and they do not acquire 
the cocaine habit. 

Local Action. — The alkaloid, cocaine, was discovered 
in 1860. It was noticed at that time that it produced 
numbness when placed on the tongue but no practical 
application was made of this discovery until 1884. 
Cocaine has no effect on the unbroken skin but when 
placed on mucous membranes, in the eye, or injected 
into subcutaneous tissue it causes paralysis of the 
sensory nerve endings and constriction of the capillaries 



134 DRUGS WHICH ACT ON NERVOUS SYSTEM 

and small arteries (see Fig. 11, page 138). The result 
is a bloodless anesthetized area around the point of 
application, an ideal condition for minor operations. 
Anesthesia is produced in about five minutes and lasts 
about a half-hour. 




Fig. 



10. — Cocaine plant. Growing in the New York Botanical 
Garden, Bronx Park, New York City. 



The constriction of the arteries is an advantage also 
because it prevents too rapid absorption of the cocaine. 
If the drug is taken into the blood too quickly the local 
action does not last and undesirable systemic effects 
are produced. If, however, the constriction is too great 
and the drug remains a long time in the tissues 



ACTION ON THE PERIPHERY 135 

unabsorbed, it is liable to destroy them. This explains 
a certain proportion of cases of abscesses and gangrene 
following the administration of cocaine. A physician 
then must regulate the dose so as to avoid too rapid 
absorption on one hand and too slow absorption on the 
other. 

Systemic Action. — If any considerable amount of 
cocaine is absorbed it stimulates the brain like caffeine, 
causing a condition of excitement and wakefulness. 
Larger closes stimulate the viedulla, affecting chiefly 
the vasomotor centre and producing a rise in blood- 
pressure. This is a striking symptom of poisoning by 
cocaine. It also causes more rapid heart action and 
respiration and a general feeling of well-being. The 
period of stimulation and excitement . is followed by 
depression and in some cases by sudden collapse. 
Cocaine is practically never given for its systemic 
action but some very susceptible people get the 
systemic effect by absorption from local treatments. 

Other Uses. — In eye surgery cocaine is quite indis- 
pensable. Besides causing anesthesia it dilates the pupil. 
^When cocaine is injected into the spinal canal for 
surgical operations it paralyzes the sensory nerve cells 
there, and causes general insensibility below the point 
of injection. In inflammatory conditions of the pharynx 
and nose cocaine acts as an astringent to reduce swelling 
and irritability. It is particularly efficient in checking 
capillary hemorrhage. 

Administration. — The common form of this drug for 
local application is cocaine hydrochloride in solutions 
from 2-10 per cent, in strength. They do not keep 



136 DRUGS WHICH ACT ON NERVOUS SYSTEM 

well and cannot be repeatedly boiled for sterilization. 
A safe dose of this drug internally is about \ grain 
(0.03 Gm.). The wine and fluidextract of coca are 
occasionally used to check emesis due to a local irrita- 
tion, and to relieve pain from ulcers of the stomach. 

Substitutes. — Various substitutes have been prepared 
in an attempt to find an efficient local anesthetic 
which will not spoil in solution and which has no 
dangerous after-effects. Stovaine, eucaine, novocaine, 
tropacocaine, all chemically related to cocaine, are 
examples of these, but cocaine still remains the most 
reliable under all circumstances. 

Toxicology. — Whenever cocaine is used locally the 
possibility of too great absorption must always be 
borne in mind. Some of the symptoms of absorption 
are headache, dilated pupils, nausea, palpitation of the 
heart, insomnia and even sudden collapse. If an 
overdose has been taken by mouth and early treat- 
ment is possible, give the usual first-aid treatment for 
alkaloid poisoning. All other treatment is sympto- 
matic. In the excitement stage apply an ice-bag to 
the head, keep the head low, and use every means to 
calm the patient's mind. The doctor will probably 
order bromides or some other mild sedatives. This 
stage is seldom dangerous and care must be taken not 
to increase the depression which is sure to follow. When 
depression begins, direct all treatment to stimulation 
of the respiratory centre. A nurse can give artificial 
respiration if convulsions are present. Strychnine 
and caffeine are the physiological antidotes. Caffeine, 
according to some authorities, tends to increase the 



ACTION ON THE PERIPHERY 137 

effect of the poison in some cases and should be 
avoided. 

Habit. — The cocaine habit is more easily formed than 
that of morphine. It is not uncommon among nurses, 
doctors, and druggists. An habitue lacks self-control, 
is melancholy and languid, and has very low standards 
of living, physically, mentally, and morally. 

Quinine and Urea. — A new local anesthetic is 
quinine and urea hydrochloride, also called bimuriate of 
quinine and urea. It is given subcutaneously in saline 
solutions about J of 1 per cent, in strength. Stronger 
solutions interfere with healing processes. The action 
is prompt and continues for several hours. Quinine 
salts are not very soluble and when injected subcu- 
taneously alone are highly irritating. This double salt 
is easily soluble and well adapted to hypodermic use. 

Ethyl Chloride. — Ethyl chloride (kelene, a trade 
name,) is used to some extent as a local anesthetic 
(page 121). It is sprayed directly on the field of 
operation, and by its very rapid evaporation freezes 
the tissues thus causing insensibility. 

Anodynes. 

In this classification of drugs an anodyne is con- 
sidered a drug which is applied locally to relieve pain, 
in distinction from an analgesic which acts systemic- 
ally. It is sometimes defined as a mild analgesic. 
Anodynes usually produce their effect by paralyzing 
the sensory nerve endings. Pain is often easily relieved 
by removing the cause; at other times by means of a 
counter-irritant. In some cases, however, local applica- 



138 DRUGS WHICH ACT ON NERVOUS SYSTEM 

tions of drugs are necessary until conditions can be 
adjusted. 

The important anodynes are atropine, aconite, 
menthol, camphor, and methyl salicylate. Atropine 
(see Fig. 11) is used for its local action chiefly 
in the form of a belladonna plaster. Aconite, a drug 
which will be studied under the circulatory system 



Depression 



Cocaine 
Atropine 

(locally) 
Phenol 



Atropine 
(small doses) 



Ergotoxine 
(large doses) 




Stimulation 



Gentian and 

other stomachics 

(taste organs) 



Pilocarpine 



Epinephrine 

Ergotoxine 

Phtjsostigmin 



Fig. 11. — Diagram of drugs which act on the periphery. 



page 157), is applied locally in the form of a tinc- 
ture to relieve the pain of neuralgia. The tincture 
should never be applied to mucous membranes because 
it is readily absorbed from them and causes dangerous 
heart symptoms. Menthol is a substance chemically 
allied to camphor which is obtained from the oil of 
peppermint. Its name is derived from the first part 



ACTION ON THE PERIPHERY 139 

of the botanical name of peppermint, mentha piperita. 
Menthol, in the form of pencils, is rubbed on the skin 
or inhaled for headaches. It has a mild action but is 
very acceptable because it is followed by a sensation 
of coolness. Camphor has a similar action. Menthol 
and camphor are common ingredients in solutions, lini- 
ments, and ointments, and may be taken internally for 
gastric pains. Menthol is contained in many proprie- 
tary remedies such as Anodyne Balm, Analgesic Balm, 
Baume Analgesique Bengue, Antineuralgic Ointment, 
and Analgesic Cream. 

Methyl salicylate as an internal remedy has the specific 
action of salicylates in rheumatism (page 223), but when 
applied locally it is an anodyne. It is a synthetic 
compound, an aromatic and almost colorless liquid, 
which is practically identical with the oil of winter- 
green (gaultheria) and the oil of birch (betula) . Methyl 
salicylate or the natural oils, alone or in liminents, 
may be applied locally to relieve pain in inflamed 
nerves or rheumatic swellings. As these substances 
are absorbed quite readily from the skin, local applica- 
tions may produce typical salicylate action. 

Mydriatics and Myotics. 

Mydriatics are drugs which produce dilatation of the 
pupil of the eye; myotics produce contraction. As has 
already been seen, some drugs produce one or the other 
of these effects in the eye when used internally for 
other purposes, such as morphine and atropine. When 
the actions are desired in eye treatments the drugs 



140 DRUGS WHICH ACT ON NERVOUS SYSTEM 

are prepared in solution and dropped directly into 
the eye. 

Action. — There are two sets of muscles which regulate 
the size of the pupil of the eye; the circular, the 
function of which is to keep the pupil small and the 
radial which has the opposite function. The size 
at any one time depends on the balance Between the 
two sets. A drug may cause a change in its size by 
acting on these muscles themselves or on the endings 
of the nerves which control them, usually the latter. 

Mydriatics.— Mydriatics are used (1) in examinations 
of the eye to enable the examiner to see the interior 
portion; (2) to rest the muscles; (3) to check a spread 
of inflammation; and (4) to prevent the formation of 
adhesions. Other mechanisms are often affected 
by the same drugs. Some, for instance, paralyze the 
accommodation of the eye, that is, its power to adjust 
its focus on near and far objects. This action is solicited 
when glasses are to be fitted. 

Atropine sulphate is a mydriatic which also paralyzes 
the accommodation. These conditions are produced 
to their full extent in about two hours and last from 
a few days to two weeks. The prolonged effect makes 
it undesirable for diagnostic purposes, but very useful 
in controlling inflammation and preventing adhesions. 
A 1 per cent, solution is commonly used. Homa- 
tropine is an artificial alkaloid chemically allied to 
atropine. Its hydrobromide is the salt usually used. 
It has the same effect as atropine on the eye but is 
more prompt in action and the effect is more fleeting. 
It is preferable, therefore, in eye examinations and in 
fitting of glasses. It also is used in a 1 per cent, solution. 



ACTION ON THE PERIPHERY 



141 



Scopolamine in very weak solutions (0.2 per cent.) is 
similar in action to the two previous drugs. It is very 
prompt and is claimed by some ophthalmologists to be 
less irritating than atropine. The hydrobromide is used. 
Myotics. — Myotics are used alternately with my- 
driatics to break up adhesions and to restore the 
natural condition of the pupil after examinations. 
An important use of myotics is in the treatment of a 





Cocaine- 
Ether {4th stage) 
Atropine and 
allied drugs. 



Following 
drops 
in eye. 



Physostigmine 
Pilocarpine 



Cocaine 
Atropine and 

allied drugs. 
Homatropine. 



Fig. 12. — Common drugs which affect the size of the pupil of the eye. 



common disease of the eye called glaucoma. One 
characteristic of this disease is a very high tension of 
the fluids inside the eyeball (intra-ocular tension). 
This may be decreased by lessening the secretion of 
the fluids and by keeping open the channels of their 
escape. As the exits are covered when the pupils are 
dilated, myotics are indicated. 

Physostigmine. — Physostigmine, the most important 
myotic, is an alkaloid derived from physostigma, a 
bean plant resembling our lima bean. It is commonly 
known as Calabar bean, Calabar being the name of 



142 DRUGS WHICH ACT ON NERVOUS SYSTEM 

a town in Africa in the region where it grows. The 
alkaloid is recognized in the French Pharmacopoeia as 
eserine, and the two names are used interchangeably 
in this country. 

This drug is a deadly poison and used among the 
natives of Africa as a test for witchcraft. If the 
suspected person dies after eating the beans, that is 
considered proof that he is guilty; if not, he is 
thought innocent. The guilty, however, have ways 
of avoiding the action of the drug and survive while 
the innocent die. In ophthalmology physostigmine 
salicylate is a most valuable myotic. Its action begins 
in a few minutes and continues over several days. 
It sometimes causes disagreeable twitching of the 
eye muscles which make it not altogether desirable 
in counteracting the effect of mydriatics. It is used 
in 0.5 per cent, solutions. 

Pilocarpine. — Pilocarpine is an alkaloid obtained from 
the leaves of a low shrub of Brazil called pilocarpus 
or Jaborandi. Pilocarpus has a stimulating effect 
on the scalp, and in formulae for hair tonics the term 
Jaborandi is usually used. This drug is an important 
one for its action on sweat glands. (See Diaphoretics, 
page 200). Asa myotic pilocarpine hydrochloride is 
used in from 0.5-1 per cent, solutions. It is weaker 
in action than physostigmine but is used for the same 
conditions. Physostigmine is usually preferred. 

ANTISPASMODICS. 

As the name implies antispasmodics are medicines 
given to prevent or relieve spasms. Disorders which are 



ANTISPASMODICS 143 

spasmodic in nature are hysteria, epilepsy, hiccoughs, 
asthma, convulsions of pregnancy, spasms of the heart 
in angina pectoris, headaches caused by spasms of the 
arteries, coughs, and the cramps of menstruation. 
With such a range of disorders there would be neces- 
sarily many remedies acting in a variety of ways. 
Some of these conditions are due to overstimulated 
muscles, some to overstimulated nerves, and some 
to a lack of inhibitory control of the muscles by the 
nerves. 

Depressants. — The group of medicines which are 
antispasmodic by depressing overstimulated muscles, 
the nitrites, will be studied in the next chapter. Those 
which quiet overstimulated nerves are the central 
nerve depressants, morphine, scopolamine, hydrated 
chloral, and the bromides and the peripheral depressant, 
atropine. 

Stimulants. — The stimulating antispasmodics are oil 
of peppermint, capsicum, asafetida, valerian, and Hoff- 
mann's Anodyne. The first two relieve spasmodic con- 
ditions by their actions as carminatives (page 185). 

Asafetida and Valerian. — As the active principles of 
asafetida and valerian are volatile oils they also are 
carminative but their action in hysteria, for which 
they are most valuable, is due largely to their odor. 
To most people the odor is very repulsive, but to one 
in a hysterical state it not only is often pleasing but 
by some psychic influence it stimulates the higher 
nerve centres. These two drugs are often termed anti- 
hysterics. The official preparations of valerian are 
the tincture, fluidextract, and the ammoniated tincture. 
The last; the most commonly used, is made by extract- 



144 DRUGS WHICH ACT ON NERVOUS SYSTEM 

ing the drug with the aromatic spirit of ammonia, 
a synergistic remedy. Its dose is 30 minims (2 Cc). 
Asafetida is a gum resin from Asia and is there valued 
as a condiment. The preparations most used are the 
pills (dose 2-3) and the emulsion, dose J-l ounce 
(15-30 Cc). It may be used as an enema for flatulence 
in the proportion of 2 grains to 4 fluidounces of water 
(0.1 Gm.-120 Cc). 

Hoffmann's Anodyne. — Hoffmann's Anodyne is the 
Compound Spirit of Ether, the ether being in the 
proportion of 33 to 65 of alcohol. Its medicinal action 
then is due as much to alcohol as to ether. Its special 
value is in relieving spasmodic conditions due to dis- 
tention of the alimentary canal, such as dyspnea, 
heart symptoms, and colic of the stomach or intestines. 
In these conditions the anodyne acts by removing 
the cause. Both ether and alcohol, by stimulation of 
the mucous membrane, cause the expulsion of the gas, 
and alcohol by reflex action stimulates the heart and 
respiration. 

Administration. — The dose of Compound Spirit of 
Ether (Hoffmann's Anodyne) is 1 dram (4 Cc). There 
are several facts in regard to this preparation which 
are important for a nurse to remember. It is inflam- 
mable, it is highly irritating, it has a very bad odor 
and taste, and the eructations of gas following its use 
taste of ether. It must therefore be kept away from 
an exposed flame; it must be given very dilute and 
on cracked ice or sugar, and every possible measure 
taken to relieve the patient of the taste and odor of 
ether after the drug begins its action, 



CHAPTER XII. 
MUSCULAR SYSTEM. 

There are no medicines which act directly on volun- 
tary muscles. The only way in which their condition 
can be improved is by general tonics, physical exercise, 
and massage. There are a few which act on involuntary 
muscles causing them to contract or to relax. Upon 
the involuntary muscles depends very largely the con- 
dition of one entire system of the body, the circulatory 
system, and by giving drugs which act on these muscles 
important changes can be brought about in that system. 
For example, drugs which improve the tone of the heart 
muscles increase the force of the heart beat; drugs 
which cause the muscles in the walls of the arteries 
to relax lower blood-pressure and increase the rate 
of the heart. There are also drugs which act on the 
muscles of the uterus and of the intestines. 

The important medicines which are known to act 
directly on muscle tissue are digitalis, strophanthus, 
and ihe nitrites, all of which affect the circulatory 
system, and pituitary extract which also acts on the 
uterus. A less important one is physostigmine, used 
as a myotic and sometimes as a cathartic. 

MUSCLE TONICS. 

Digitalis and Strophanthus. — Source. — These two 
drugs are so similar in action that they will be con- 
10 



146 



MUSCULAR SYSTEM 



sidered together. Strophanthus is by far the more 
toxic of the two. The drug, digitalis, is the powdered 
dried leaves of the well-known plant, digitalis or fox- 
glove. The supply for medicine comes chiefly from 
Europe. Strophanthus is the seed of a native plant 
of Africa which is used there as an arrow poison. 




Fig. 13. 



-Digitalis plant. Grown in the school garden at Teachers 
College, New York City. 



Review of Structure and Action of Heart. — The action 
of these drugs is comparatively simple if the anatomy 
and physiology of the heart are understood. It is 
probable that in therapeutic doses they act wholly on 
the heart itself, little on the nervous system, and 
none at all on the arteries. 



MUSCLE TONICS 



147 



From the study of Physiology it is learned that all 
muscles in a normal state have tone, a maintained 
degree of contraction, the power of irritability, that is, 
of receiving stimuli from the nerves, and the power 
of contractility. The muscle fibers of the heart have 
the power of rhythmic contraction, manifested in the 
beat of the heart. The original stimulus comes first 
to the auricles, this continues as a wave on through 
the auriculoventricular bundle (see diagram) to the 




Fig. 14. — Diagram of heart. Auriculoventricular bundle. 



muscles of the ventricles. Therefore in normal con- 
ditions the auricles beat first, each beat is followed at 
once by the beat of the ventricles, and the ventricular 
beat determines the rate of the pulse. 

Pathological Conditions of Heart. — If for some reason 
the wave of contraction from the auricles to the 
ventricles is interfered with, the ventricles still beat 
by themselves, but at a very slow rate, about 30-40 
per minute. This condition is called "heart block." 



148 MUSCULAR SYSTEM 

When the heart becomes overirritable, instead of 
the harmonious contraction of all the fibers of the 
auricles or of the ventricles little individual bundles 
of fibers act by themselves and the rhythm of contrac- 
tion is lost. This is said to be a state of fibrillation; 
if in the auricles, auricular fibrillation, if in the ven- 
tricles, ventricular fibrillation. The latter is a serious 
condition probably always fatal; the former is in 
itself a very serious condition and at times tends 
to produce the latter. 

Effects on Pidse. — Some of the pathological con- 
ditions which occur in the heart are briefly outlined 
below so that the action of digitalis and strophanthus 
may be more clearly understood. 

Pathological Condition. Kind of Pulse. 

1. Loss of tone, contractility, Weak, regular rhythm. 

or irritability. 

2. Excessive irritability, " fibril- Rapid, irregular rhythm. 

lation." 

3. Heart block. Very slow, or sudden change 

from fast to slow. 

4. Valvular lesions. 

Therapeutic Action. — Primary. — Digitalis and stro- 
phanthus often, but not always, improve the first 
condition by restoring the muscles to their normal 
condition. Their greatest use, however, is in auricular 
fibrillation. They act in this case by increasing the 
tone of the muscles and by creating a beneficial heart 
block. The first restores the rhythm, the latter slows 
the rate of the pulse. Slowing of the ventricular 
beat by these drugs is largely due to a stimulation 
of the vagus centre and to a certain degree of heart 



MUSCLE TONICS 



149 



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Fig. 15. — Record of the heart beat and the pulse beat during the 
first five days of a case in the Presbyterian Hospital, New York, 
of chronic decompensation complicated with auricular fibrillation, 
mitral stenosis, and insufficiency. The first order was infusion of 
digitalis, 3j, 4 i. d. At 5.30 p.m. on the first day strophanthin, gr. 
2 J , was given intravenously and at 11.30 p.m. the dose was repeated 
hypodermically. On the second day the standing order was changed 
to TH,x of digalen (a preparation of digitoxin) by hypodermic injection 
q. 4 h., and on the fifth day the dose was reduced to Tfl.v. 



150 MUSCULAR SYSTEM 

block. Auricular fibrillation is sometimes a chronic 
condition, but more or less continuous administration 
of one of these heart tonics may maintain fairly good 
health. As digitalis in overdoses may cause heart 
block, it is contra-indicated for general use in the third 
pathological condition. In valvular troubles these 
drugs are used to correct a failure of compensation 
of the heart by increasing the force of its contractions. 

In cases where there is cardiac weakness the muscular 
contractions of the heart have not sufficient force to 
transmit all the beats to the pulse, and while the 
heart is beating very rapidly the pulse beat is slow 
or entirely absent. The effect of the heart tonics in 
such cases is to slow the heart beat and increase the 
pulse beat (see Fig. 15). 

Secondary. — The secondary result of the action of 
these drugs on the heart is improvement in the general 
circulation, and as a result of that the blood gets 
more oxygen, all organs including the heart itself are 
better nourished, blood-pressure may be raised, 
lowered or remain unaltered, and any edematous 
condition removed if it is due to poor circulation. In 
cases of edema an increased diuresis necessarily follows 
the administration of digitalis and strophanthus to 
carry the extra fluids from the blood. There is likely to 
be nausea attending the administration of these drugs. 

Administration. — Digitalis. — Digitalis may be given 
in the form of the powdered leaves, dose 1 grain (0.064 
Gm.), the tincture (10 per cent.), dose 15 minims (1 Cc), 
or the infusion, dose 2 fluidrams (8 Cc). These doses 
in severe cases may be much increased. All the active 
principles of these drugs are glucosides. There has 



MUSCLE TONICS 151 

been much confusion in the isolation and naming of 
these principles and still more in the clinical results 
of their use. The glucosides of digitalis which have 
had some use are digitoxin, digitalin, and digitalein. 
Digitoxin, dose 2 5~o" grain (0.00025 Gm.), most com- 
pletely represents the action of digitalis but is very 
irritant when given subcutaneously and is not suffi- 
ciently soluble in water for this purpose. A new 
proprietary form of digitalis which has proved of 
value is digipuratum. This is an extract of digitalis 
largely freed from its irritant principles and mixed with 
sugar of milk. It is supplied in tablet form (one tablet 
= one dose of digitalis) and in solution for injection 
into the tissues or the veins (15 minims (1 Cc.) = one 
dose of digitalis). 

Strophanthus. — Strophanthus is given in the form of 
the tincture, dose by mouth 8 minims (0.5 Cc). Its 
oral use is by no means safe as its absorption is very 
variable and a continued administration of even small 
doses has caused serious results without preliminary 
symptoms. The glucoside of strophanthus is stro- 
phanthin. Strophanthin-k, strophanthin-g, and g- 
strophanthin indicate merely the different species of 
the plant from which they are derived. Strophanthin-k 
is the glucoside commonly called simply strophanthine 
its dose being tijo" grain (0.0003 Gm.). g-strophanthin, 
also called ouabain (pronounced wa-ba-ene), is com- 
monly given intramuscularly or intravenously, the maxi- 
mum single dose being about rio" grain (0.0005 Gm.). 

Strophanthin or ouabain should not be given intra- 
venously in the above doses within two weeks after 
a full course of digitalis which is very persistent in 



152 MUSCULAR SYSTEM 

action. Therefore a, nurse should record and report 
accurately the cessation of previous digitalis treatment. 

Special Factors in Administration. — There are several 
factors which determine the method of giving these 
drugs. If they are given by mouth eighteen to twenty- 
four hours pass before they manifest any action at all. 
In emergency cases strophanthin or ouabain are given 
intravenously or intramuscularly. When the action 
has once started the doses are regulated in size and 
interval to suit the individual case. As digitalis 
is persistent in action, the intervals between doses 
are long and after the drug has been entirely stopped 
the effect will continue from one to three weeks. On 
account of this prolonged action and the fact that the 
crude drugs and their glucosides all act alike, it is 
important for a doctor on a new case to know if the 
patient has been using these remedies in any form and 
if so when the last dose was taken. 

Toxicology. — In case of overdosing, if treatment is 
possible before absorption, give lavage with potassium 
permanganate. The toxic symptoms are a marked 
nausea, a very slow pulse, or any sudden change 
in the character of the pulse from fast to slow, regular 
to irregular, or vice versa. When any of these con- 
ditions appear, they should be reported, the drug 
stopped, and the patient kept quiet and warm until 
the arrival of a physician. 

MUSCLE DEPRESSANTS. 

Nitrites. — The nitrites, as a class of medicines, 
include sodium nitrite (NaN0 2 ), amyl nitrite (C 5 HnN0 2 ), 



MUSCLE DEPRESSANTS 



153 



and three nitrates which break down to nitrites, nitro- 
glycerin (C 3 H 5 (N0 3 )3), erythrol tetranitrate, and potas- 
sium nitrate (KN0 3 ). 

Action. — Their action is due to the nitrite radical, 
N0 2 , which is a muscle depressant, that is, it causes the 
muscle fibers to relax. Their effects are seen chiefly 
on the muscles of the arteries and of the bronchi, the 
result being a relaxation of the bronchial wall and a 
dilatation of the arteries. The obvious secondary 



2 Hours 



2V 2 Hours 




Fig. 16. — The extent of the fall of pressure is measured along 
the vertical line; the duration along the horizontal line, a = 
amyl nitrite, b = nitroglycerin, c = sodium nitrite, d = erythrol 
tetranitrate. (Bradbury.) 



effects are a rapid, sometimes bounding, pulse and 
quickened respiration. In therapeutics the nitrites 
are used (1) to lower blood-pressure for the purpose 
of relieving an overworking heart in diseases char- 
acterized by a high blood-pressure, such as arterio- 
sclerosis, chronic nephritis, and angina pectoris, and 
(2) to relax the bronchial tubes in asthma. 

Comparison. — The individual members of this group 
of drugs differ in their speed and permanence of action 
more than in degree. Fig. 16 presents these variations 
graphically. It is readily seen that amyl nitrite is 
best adapted to emergency use in certain hysterical 
conditions and heart spasms; nitroglycerin and sodium 



154 MUSCULAR SYSTEM 

nitrite to moderate general action, and erythrol tetra- 
nitrate to chronic diseases and prophylaxis. 

Description. — Amyl nitrite is highly volatile and is 
always given by inhalation. It is prepared in ampules 
of colored glass, each containing one dose, 3 minims 
(0.2 Cc.) . When a dose is needed an ampule is broken 
in gauze or a handkerchief and the contents inhaled. 
Sodium nitrite is given in powder or tablet form, the 
dose being 1 grain (0.064 Gm.). Nitroglycerin is given 
by mouth or by hypodermic injection, the rate of 
action being about equal by the two methods. The 
dose is gr. yyo (0.6 mg.). The chemical name of 
nitroglycerin is glyceryl trinitrate and the official 
preparation is a 1 per cent, spirit of glyceryl trinitrate, 
known also as spirit of glonoin. As it is a 1 per cent, 
spirit the dose is 1 minim (0.06 Cc). Nitroglycerin is, 
however, usually given in the form of a tablet triturate. 
Because of the volatility of this drug these tablets will 
be of variable strength unless they are kept tightly 
stoppered. Erythrol tetranitrate is a preparation in 
tablet form, 1 grain (0.06 Gm.) being in each 
tablet. The last two drugs are highly explosive, and 
a nurse must never attempt to crush the tablets before 
administration or allow one to drop on the floor where 
it might be crushed under foot. Potassium nitrate is 
administered by burning the drug or a paper saturated 
with it and causing the fumes to be inhaled. The 
nitrate is converted to the nitrite in the process of 
burning. This drug is an ingredient of most popular 
asthma powders. 

Toxicology. — Ordinary doses of nitrites may cause 
headache, dizziness, flushing of the face, and occa- 



MUSCLE STIMULANT 155 

sionally collapse. Recovery is usually prompt but 
if treatment is needed give artificial respiration and 
stimulants. 

MUSCLE STIMULANT. 

Pituitary Extract. — Pituitary extract is usually in the 
form of a liquid preparation obtained from the posterior 
lobe of the pituitary gland. No active principle has 
as yet been isolated in pure form, pituitrin being 
simply a trade name for a purified extract. This drug 
is still in an experimental stage but it seems to be 
a direct muscle stimulant. Its action is manifested 
chiefly on the arteries and the uterus, causing those 
organs to contract. Indirectly the contraction of the 
arteries raises blood-pressure and increases the force 
of the heart beat. The arteries of the kidneys seem 
for some reason to be unaffected, and as this results 
in a much increased blood supply in those organs, 
diuresis may follow. Pituitary extract has been used 
with some success in hemorrhage from the lungs. 
If administered immediately after surgical operations 
it tends to increase the force of the heart; if given 
from six to eighteen hours later it assists in relieving 
flatulence. Its greatest use is in obstetrics. When 
given late in labor it increases the force of the con- 
tractions of the uterus and hastens delivery. It seems 
to lessen the danger of postpartum hemorrhage, and 
in some cases to obviate the need of catheterization 
following labor. It is given intravenously or sub- 
cutaneously in doses of 15 minims (1 Cc). 



CHAPTER XIII. 
CIRCULATORY SYSTEM. 

The condition of the circulatory system can be altered 
by drugs through four different channels. Some drugs 
act directly on the heart; some change the calibre 
and tone of the bloodvessels; others affect the nerve 
centres controlling these organs; and some change the 
constituents of the blood. The parts of the circulatory 
system are so inter-related that a change in the con- 
dition of one affects the whole system. 

DRUGS WHICH ACT ON THE HEART. 

Heart Stimulants. 

Drugs which act on the heart through the nervous 
system are true heart stimulants. They are strychnine, 
caffeine, camphor, and atropine. Ammonium is a cardiac 
stimulant which through reflex action increases the 
rate of the heart. (See Ammonium, page 170). Its 
effect is rapid but transitory. All these drugs increase 
the rate of the heart beat, not necessarily its force. 

Heart Depressants. 

Morphine, hydrated chloral, and the bromides in small 
doses are heart depressants and decrease its rate. 



DRUGS WHICH ACT ON THE HEART 157 

Aconite, which has already been mentioned as an 
anodyne, is a drug of very complex action on the 
nervous system which may be classed as a heart 
depressant. Its use is gradually being abandoned 
because of its extreme toxic action on the heart. It 
has some use in short acute fevers. (See Antipyretics, 
page 214.) The tincture is the preparation commonly 
used, the dose of which is 3 minims (0.2 Cc). The 
characteristic symptom of aconite poisoning is tingling 
of the mouth and throat immediately after swallowing, 
next of the finger tips, and later of the whole body. 
First-aid treatment is lavage, absolute rest, and exter- 
nal heat. Later treatment will be to support .the 
respiration. 

Another heart depressant is veratrum, synonym hele- 
bore, a drug the use of which is practically limited 
to the treatment of eclampsia. Its action is to slow 
and quiet the heart by stimulation of the vagus centre 
and to reduce blood-pressure. There are two different 
species of veratrum from which the alkaloids veratrine, 
cevadine, and proto veratrine are obtained. The crude 
drug is usually used in the form of the fluidextract, dose 
1-3 minims (0.06-0.2 Cc). 

Heart Tonics. 

Digitalis and strophanthus are true heart tonics 
because they increase its nutrition and the force of its 
beat. They slow the rate of the heart but leave it well 
nourished and strong. 

Therapeutic Use of Heart Drugs. — Heart stimulants 
are indicated in crises as in shock or in acute diseases. 



158 CIRCULATORY SYSTEM 

Heart depressants are needed most often in nervous 
disorders when the whole nervous system is in an 
irritable state. They are also used to lower blood- 
pressure. Heart tonics are indicated in the diseased 
conditions of the heart itself, resulting from overstrain 
or toxins from some infectious disease of the body. 

DRUGS WHICH ACT ON THE ARTERIES. 

Vasodilators. 

Drugs which relax the walls of the arteries are called 
vasodilators; those which constrict them, vasocon- 
strictors. Both classes are used to affect blood-pressure 
and, through it, the heart. The nitrites (page 152) are 
vasodilators, and are indicated in diseases character- 
ized by high blood-pressure as arteriosclerosis, chronic 
nephritis, angina pectoris, eclampsia, and other spas- 
modic conditions. They relieve an overworking heart, 
decreasing its force and increasing its rate. 

Vasoconstrictors. 

Vasoconstrictors are used locally to check hemor- 
rhage, systemically to raise blood-pressure in shock 
and collapse and to increase the force of the heart. 
Pituitary extract (page 155) is a vasoconstrictor by 
its action on the muscles of the arteries. A more 
important drug of this class is epinephrine which acts 
on the nerve endings of the arteries. 

Epinephrine. — Epinephrine is an alkaloid derived 
from the adrenal gland of animals, chiefly cattle and 



DRUGS WHICH ACT ON THE ARTERIES 159 

sheep. Its chloride was first produced in commercial 
form by Parke, Davis & Company under the trade 
name of adrenalin chloride. Other drug firms and 
meat-packing houses have put similar preparations on 
the market under the names supracapsulin, adnephrin, 
suprarenin synthetic and others. (See N. N. R.) 

Action. — Epinephrine stimulates the endings of all 
nerves which pass through the sympathetic system 
but in therapeutics its use is limited chiefly to stimula- 
tion of vasoconstrictor nerve endings (see Fig. 11, 
page 138). It also stimulates at the same time the 
vasodilator nerve endings with the result that after 
the constrictor action is passed the arteries, instead of 
resuming their normal size, become very much dilated. 
This limits the use of epinephrine as a hemostatic, 
a remedy to check hemorrhage. For the same reason 
when epinephrine is used over long periods in the nasal 
cavities for hay fever it is liable to produce a chronic 
inflammatory state. In the bronchi the dilator action 
only is apparent and is used in asthma. 

Methods of Administration. — The greatest use of 
epinephrine is as a hemostatic. If taken by mouth it 
exerts only a local action on the stomach as it is 
destroyed by the gastric juices before absorption. 
If injected subcutaneously it acts around the area of 
injection and is only slightly absorbed. It is given 
in this way in combination with cocaine in minor 
surgery for its local vasoconstrictor action and in 
asthma alone for its bronchodilator action. When 
given intramuscularly the systemic action is more 
pronounced and by this method in postpartum 



160 CIRCULATORY SYSTEM 

hemorrhage the uterine muscles are contracted, thus 
mechanically closing the open ends of the bloodvessels. 
By intravenous injection the greatest systemic effects 
are produced but they are very fleeting, often lasting 
not more than five minutes. This method is employed 
for emergency treatment to raise blood-pressure. 

Therapeutic Uses. — The chief therapeutic uses of 
epinephrine are: 

1. To check hemorrhages on abraded surfaces of 
the skin and mucous membranes. 

2. To relieve asthma (subcutaneously) . 

5. To check postpartum hemorrhage (intramus- 
cularly or by douche) . 

6. To raise blood-pressure in shock or collapse 
(intravenously). 

Dosage. — For local application the solution of 
adrenalin chloride is used. It is supplied for* this 
purpose in a 1 to 1000 solution, and can be applied 
full strength on the skin but should be diluted to 1 to 
5000 or 1 to 8000 for use on mucous membranes. 
15 minims (1 Cc.) of the 1 to 1000 solution is the dose 
for hypodermic or intramuscular injection. The same 
dose is given by vein and has to be given very slowly 
to avoid heart failure by a sudden rise of blood-pressure 
or by direct action on the heart. 

Tyramine; Ergotoxine. — Tyramine and ergotoxine 
are two alkaloids derived from ergot (page 229) 
which are very similar to epinephrine in composition 
and action (see Fig. 11, page 138). These alkaloids 
are used as vasoconstrictors to raise blood-pressure 
in shock or collapse. Their action is not so 
prompt as epinephrine but three or four times more 



DRUGS WHICH AFFECT THE BLOOD 161 

prolonged. They act almost equally well by mouth, 
by subcutaneous or by intravenous injection. The 
dose of ergotoxine is grain -^ (0.0012 Gm.) ; of tyramine 
grain \ (0.03 Gm.). As ergotoxin in large doses par- 
alyzes the constrictor nerve endings, repeated doses 
are unsafe. 

DRUGS WHICH AFFECT THE BLOOD. 

The common pathological conditions of the blood 
itself are (1) decreased alkalinity; (2) decreased 
coagulability; (3) excessive coagulability; (4) deficiency 
in hemoglobin; and (5) a low percentage of red or 
white corpuscles. 

Antacids. 

An excessive acidity of the blood is a rare condition. 
It is supposed to be the cause of coma in diabetes 
and is present in delayed chloroform poisoning. In 
such cases an attempt is made to neutralize the blood 
by giving large quantities of sodium carbonate or 
bicarbonate. These salts may be administered as a 
prophylactic or as a medicine. They are given by 
mouth in very large doses, by rectum in still larger 
doses by the drop method, and in solution intra- 
venously. Results are not always good but a sufficient 
number of cases have been benefited to justify trial 
of this treatment. 

To Increase Coagulability. 

Attempts to change the degree of the coagulability 
of the blood by administration of drugs have met 
11 



162 CIRCULATORY SYSTEM 

with varying success. In severe hemorrhages and in 
hemophilia, a disease in which there is excessive 
bleeding on slight provocation, and in diseases char- 
acterized by capillary hemorrhages, the coagulability 
of the blood is much decreased. Most of the remedies 
used to restore this property are empirical but they 
are harmless and worth trial. In the diseases mentioned 
above calcium is the constituent of the blood which 
is lacking, and it is administered in the form of calcium 
chloride or lactate. It is doubtful if sufficient calcium 
is absorbed when these salts are given by mouth to 
produce beneficial results. Their administration by 
hypodermic injection is very painful. The best results 
are by intravenous injection of a weak solution. De- 
fibrinated blood of animals or ascitic fluid taken from 
some dropsical patient are tried in cases of severe 
hemorrhage, also normal blood serum from some 
animal or in the form of diphtheria antitoxin. 

To Decrease Coagulability. 

When the blood coagulates very easily clots tend 
to form in the vascular system and cause thrombosis 
or embolism. No cure for this condition has as yet 
been found. Citric acid and some of the soluble citrates 
have been tried but there is no proof that the amounts 
that can be given in therapeutics have any appreciable 
effect. 

Hematinics. 

Hematinics are medicines given to increase the 
hemoglobin content of the blood- A common 



DRUGS WHICH AFFECT THE BLOOD 163 

disease in which hemoglobin of the blood is de- 
ficient is anemia. Anemia is the predisposing cause 
of many disorders, such as chorea, heart irregular- 
ities, menstrual troubles, and many nervous conditions. 
The most rational method of treating this disease 
of the blood is by living day and night in the fresh 
air, taking exhilarating exercise, and a nourishing 
diet. This is not always possible and often needs 
to be supplemented by drugs. 

Iron. — The one great hematinic of medicine is iron 
which is an essential constituent of hemoglobin. The 
use of iron as a blood medicine dates back to very early 
times. It was based on the belief that as iron imple- 
ments were strong a medicine containing iron would 
give strength. It was administered in the form of 
water in which swords had lain for a long time and 
rusted. 

The Normal Supply. — There are from 40 to 50 grains 
of iron in a normal human body, about enough to make 
a two-inch nail. The daily demand to keep up this 
amount is very small, from ^ to i of a grain and it 
is easily supplied in an ordinary diet. In some cases 
of anemia a special diet rich in iron will effect a cure. 
If, however, the supply is -seriously depleted as after 
a hemorrhage or a wasting fever, diet alone is often 
not sufficient to make up the loss. 

Foods which are richest in iron are beef, spinach, 
the yolk of an egg, and lentils. Legumes, wheat, 
potatoes, and oatmeal are next in their iron content. 
Milk and its derivatives are very poor in iron, although 
two and a half pints of milk contain J of a grain. 



164 CIRCULATORY SYSTEM 

Action. — The action of iron as a hematinic is simply 
to supply a deficiency for the manufacture of hemo- 
globin. There may be some stimulation of the appetite 
and of the red marrow where red corpuscles are made 
but these actions are comparatively unimportant. 

Iron Compounds. — There is still much disagreement 
in regard to the comparative value of the so-called 
organic and inorganic iron. The distinction here is 
not the same as between the two branches of chemistry 
but depends on the reaction to chemical tests for free 
iron. If some chloride of iron be put into solution and 
tested with a chemical reagent for iron the presence 
of the metal is readily seen. Ferric citrate which in 
chemical terminology is an organic salt gives the same 
result in this test and is considered an inorganic prep- 
aration of iron. If iron compounds such as hemo- 
globin and ferratin be subjected to this test it is 
necessary to break down the compounds with an acid 
or even by incineration before the free iron will show. 
Such compounds are said to be organic. (See Experi- 
ment IX, page 262.) It is now a fairly well-established 
fact that all forms of iron, organic or inorganic, are 
absorbed and act as hematinics. They differ, however, 
in side actions. Many inorganic preparations of iron 
irritate the stomach, derange digestion, cause frontal 
headache, destroy the enamel of the teeth if allowed 
to come into contact with it, and are so astringent as 
to cause constipation. This is not true of organic 
iron preparations. It is probable that much smaller 
doses of inorganic iron than are commonly given would 
be just as efficient and give no side actions. 



DRUGS WHICH AFFECT THE BLOOD 165 

Dosage. — There are thirty-six official preparations 
of iron, and many more which are proprietary (see 
N. N. R.). The official compounds most used are the 
following: 

Reduced iron (made from the oxide 

by reduction by hydrogen), gr. j (0.064 Gm.) 

Pills of ferrous carbonate (Blaud's 

pills) , 2 pills 

Tincture of ferric chloride, lUviij (0.5 Cc.) 

Pills of ferrous iodide, 2 pills 

Syrup of ferrous iodide (much used 

for children), ttlxv (1 Cc.) 

Ferric and ammonium citrate, gr. iv (0.25 Gm.) 

Ferric and ammonium tartrate 

(considered the most absorbable 

inorganic iron), gr. iv (0.25 Gm.) 

Solution of ferric and ammonium 

acetate (Basham's mixture), 5J-iv (4-16 Cc.) 

These are all forms of inorganic iron and must be 
so administered as not to corrode the teeth. Some 
of the popular organic iron preparations are ferratin, 
hemaboloids, hemogallol, and ovoferrin. Iron may be 
given intramuscularly in the form of the glycero- 
phosphate, in a solution of iron and ammonium acetate 
and other forms. When taken by mouth it should 
preferably follow meals. Hemoglobin itself and extract 
of red marrow are obtained from animals and are some- 
times used as medicines but they do not seem superior 
to more palatable forms of iron. 

Arsenic. — Another drug which may be classed as a 
hematinic is arsenic. It produces especially good 
results when given in combination with iron. 

Arsenic trioxide, As 2 3 , is the form in which arsenic 
is given as a medicine. It is a white powder which in 
solution in water forms arsenous acid. 
As 2 3 + 3H 2 -> 2H 3 As0 3 

Arsenic trioxide. Arsenous acid. 



166 CIRCULATORY SYSTEM 

These properties have led to the use of numerous 
names for this drug. The terms white arsenic, arsenous 
oxide, arsenous acid, arsenous anhydride, and arsenic 
all mean arsenic trioxide when applied to the medicine. 
For convenience hereafter the last will be used. Arsenic, 
in the form of complex salts, has in the past been a 
common poison because of its use in dyes, wall papers, 
Paris green, rat poisons, and for criminal purposes. 
The percentage of it in dyes and in wall papers is now 
restricted by law. 

Therapeutic Uses. — Arsenic has four very distinct 
uses in medicine. 

1. Locally as a caustic. 

2. Internally in dry skin diseases. 

3. Internally in diseases of the blood. 

4. Internally as a specific against higher organisms. 
(See Antisyphilitics.) 

Local Action. — Locally arsenic is a caustic by creating 
such an intense inflammation that the tissues die. 
It is an ingredient in most quack cancer cures and is 
used to some extent in legitimate medicine for treat- 
ment of superficial malignant diseases and in dentistry 
to kill nerves of the teeth. The use of arsenic on the 
skin is gradually being discontinued as it is very 
painful and may be followed by systemic effects due to 
absorption. 

Systemic Action. — On Skin.- — When arsenic is given 
internally it causes the walls of the capillaries to dilate 
and thus become very much more permeable. In 
small doses this results in an increased nutrition of the 
skin. This in part explains its use in cosmetics, in 



DRUGS WHICH AFFECT THE BLOOD 167 

dry, scaly, skin diseases, and by veterinarians to give 
gloss to a horse's coat. It may also account for the 
improvement in digestion which often follows a course 
of arsenic. After large doses this action results in a 
general edema shown by puffiness about the eyes and 
an inflammatory condition of the alimentary canal. 
In cases of poisoning the extreme inflammation causes 
sloughing of the gastro-intestinal mucous membrane 
with resulting white or " rice-water" stools. 

On Blood. — Diseases of the blood are benefited by 
the increased nutrition of the blood-making tissue, 
the red marrow of the bones. It seems to cause some 
increase in the number of red corpuscles, but little 
in the amount of hemoglobin. Arsenic does, however, 
very much benefit some diseases in which red corpuscles 
are being destroyed, as in pernicious anemia. Its 
greatest use is in diseases in which the leukocytes are 
abnormally increased, as in leukemia. 

Dosage. — Arsenic is most frequently given in the 
form of the Solution of Potassium Arsenite (Liquor 
Potassii Arsenitis), popularly called Fowler's Solution. 
This preparation does not keep well. Its dose is 3 
minims (0.2 Cc). The Solution of Arsenous Acid, 
same dose, and the Solution of Arsenic and Mercuric 
Iodide (Donovan's Solution), dose 1J minims (0.1 
Cc), are other preparations of arsenic. Atoxyl and 
salvarsan are complex arsenic compounds used chiefly 
for specific action in syphilis (see page 221). Sodium 
cacodylate is a synthetic compound which breaks down 
slowly in the body and liberates arsenous acid. Because 
of its slow decomposition it is claimed to be less toxic 



168 CIRCULATORY SYSTEM 

and freer of side actions than ordinary forms of arsenic. 
As it tends to decompose in the juices of the stomach 
it is often given by hypodermic injection. Its dose is 
\ grain (0.03 Gm.). 

Some physicians believe that arsenic is at all times 
best given by hypodermic injection. In this way 
smaller doses are required, irritation of the alimentary 
canal is avoided, and it is claimed that toxic symptoms 
rarely appear. The injections frequently cause con- 
siderable irritation. A course of arsenic treatment is 
usually commenced with minimum doses and gradu- 
ally increased until symptoms of overdosing appear. 
A great degree of tolerance is attained. Preparations 
of arsenic by mouth are best given directly after 
meals. 

Toxicology. — Mild overdosing may be detected by 
puffiness about the eyes, coryza, and slight disorders 
of the alimentary canal. If these appear, the drug 
should be stopped but no further treatment is neces- 
sary. The symptoms of acute poisoning by arsenic are 
those of acute inflammation of the alimentary canal, 
vomiting, cramps, and diarrhea followed by low blood- 
pressure and collapse from excessive loss of fluids. The 
treatment in such cases is administration of demulcents, 
preferably milk or white of egg, to relieve the local 
symptoms and of the chemical antidote, ferric hydrox- 
ide, U. S. P. This antidote is never at hand but must 
be secured as soon as possible from a pharmacy and 
given as directed. Some investigators have found this 
antidote useless but it has not as yet been discarded. 
Radical measures to check the diarrhea should be 



DRUGS WHICH AFFECT THE BLOOD 169 

avoided as the poison is eliminated in this way. 
Further treatment is for collapse. Chronic poisoning 
by arsenic may take many forms, giving the varied 
symptoms of loss of appetite, emaciation, fever, 
sneezing, coughing, jaundice, extreme neuritis, and 
pigmentation of the skin. 



CHAPTER XIV. 
RESPIRATORY SYSTEM. 

Disorders of the respiratory system are treated 
by drugs which act on the respiratory centre and by 
those which exert a local action on the lining membrane 
of the respiratory passages. The local effect may be 
obtained by inhalation of medicines or by their ex- 
cretion through the lungs. Respiration and heart 
action are so closely related that a change in one often 
produces a like change in the other. 

The classes of drugs which affect this system by cen- 
tral action are the respiratory stimulants and sedatives. 
Those which act locally are the respiratory antispas- 
modics, antiseptics, demulcents, and expectorants. 

Respiratory Stimulants. 

Strychnine, atropine, caffeine and camphor are the 
important respiratory stimulants. Artificial respiration 
is often of more value than any drug. It rests the 
respiratory centre and keeps up the mechanical move- 
ments of respiration until the centre is able again to 
resume control. Ammonium, to be studied next, is a 
respiratory stimulant chiefly by reflex action. 

Ammonium. — The action of any ammonium com- 
pound on the respiratory system is due to the ammo- 



RESPIRATORY STIMULANTS 171 

nium ion, NH 4 . Therefore to secure this effect a 
compound must be used from which the ion is easily 
liberated. Such compounds are ammonium hydroxide, 
NH4OH, and ammonium carbonate, (NH 4 ) 2 C0 3 . The 
first is used in medicine in the form of the aromatic 
spirit, the latter in its original form always in solution. 

Action. — Ammonium hydroxide is a local irritant. 
When applied to the skin in liniments it is a counter- 
irritant, due to the liberation of the irritating ammonia 
gas, NH 3 . On mucous membranes both the hydrox- 
ide and carbonate have two actions : a stimulation at the 
point of application causing an increase of mucous secre- 
tions and a very prompt reflex action on the respiratory 
centre. Both occur whether the drug be inhaled or 
taken by mouth and excreted by the lungs. Ammo- 
nium in the blood stream is used in the manufacture 
of urea, (NH 2 ) 2 CO, but if any reaches the respiratory 
centre it directly stimulates it. 

Therapeutic Uses. — Ammonium hydroxide is used in 
therapeutics as a counter-irritant; the hydroxide and 
carbonate (1) as quick respiratory stimulants, and (2) 
to increase secretions of the respiratory tract (expecto- 
rants) . 

Dosage. — The familiar remedy for fainting, Aromatic 
Spirit of Ammonia, contains ammonia water 9 per cent., 
and ammonium carbonate 3.5 per cent., besides a large 
percentage of alcohol (see page 110), all three ingredi- 
ents being quick reflex stimulants. This is given by 
inhalation or by mouth in doses of 15-60 minims 
(1-4 Cc). Ammonium carbonate is also given by 
both methods, the dose by mouth being 4 grains 



172 RESPIRATORY SYSTEM 

(0.25 Gm.). Ammonium hydroxide or carbonate is 
the active constituent of smelling salts. As the value 
of these two drugs depends on their local irritant 
action they should not be given by mouth too dilute. 
The aromatic spirit is best diluted about four times, and 
one dose of the carbonate dissolved in. about half an 
ounce (15 Cc.) of water. There are two salts of am- 
monium used in medicine from which the radical is 
not easily liberated, ammonium chloride and acetate, 
and they act in an entirely different manner from the 
ones just described. Ammonium chloride exerts salt 
action on the respiratory passages changing the amount 
and character of the secretions. (See Expectorants, 
page 176.) Ammonium acetate by a central action 
stimulates sweating and will be considered as a dia- 
phoretic, page 201. 

Respiratory Sedatives. 

Respiratory sedatives are the central depressants, 
morphine and codeine. They are indicated in coughs 
but should be used only as a last resort because of the 
danger of habit formation. The markets are flooded 
with patent cough mixtures, many of which contain 
morphine, codeine, heroin, or chloral in large enough 
quantities to produce the drug habit and thus increase 
the sale of the medicine. Many others are so innocuous 
that administration of plain sugar syrup would do 
just as much good and be much cheaper. The nitrites 
and atropine, used as antispasmodics in asthma, may 
be included in this class. 



RESPIRATORY ANTISEPTICS 173 



Respiratory Antispasmodics. 

There are two drugs of some importance which act 
as antispasmodics on the respiratory tract. They are 
stramonium and wild cherry. The inhalation of steam 
alone has a similar soothing effect. Stramonium owes 
its activity to hyoscyamine (see page 99). Its chief 
use is in asthma and it is an ingredient of most asthma 
powders. It is always administered by burning the 
leaves in a saucer and causing the fumes to be inhaled 
or in a pipe or cigarette for smoking. Sometimes 
it is given in combination with potassium nitrate, the 
leaves being previously soaked in a solution of the 
nitrate and dried. These treatments by inhalation 
may be continued until the spasmodic condition is 
relieved and repeated whenever demanded. AYild 
cherry has for its active principle hydrocyanic acid 
which depresses the respiratory centre and the sensory 
nerve endings. It is present, however, in such small 
quantities that the usefulness of wild cherry in cough 
mixtures is probably limited to that of a flavor. 



Respiratory Antiseptics. 

The common respiratory antiseptics are guaiacol, 
creosote, benzoin, and the oil of eucalyptus. They are 
administered by inhalation and by mouth. 

Creosote and Guaiacol. — Creosote is a volatile oil 
derived by the distillation of wood tar, preferably 
from beechwood. It contains from 60-90 per cent, 
of guaiacol, a clear, colorless liquid having a similar 



174 RESPIRATORY SYSTEM 

odor and taste. Guaiacol is more constant in com- 
position and less irritating. In ordinary doses both 
these drugs tend to derange digestion; in large doses 
they are very depressing and may cause sudden 
collapse even when absorbed from the skin. In some 
way, not yet explained, they allay inflammation of the 
respiratory tract even if this inflammation is not 
septic. For inhalation they may be dropped on a mask 
or added to boiling water and inhaled with the steam. 
They are valuable in diseases of the respiratory tract 
which are characterized by a foul odor. In phthisis 
and bronchitis they may be used internally in doses 
of 3 minims (0.2 Cc). Their taste must be disguised 
in some way either by giving them on sugar, in milk, 
or in an aromatic tincture like the compound tincture 
of gentian. For internal administration the carbonates 
of creosote and guaiacol may be used, guaiacol carbo- 
nate being tasteless, odorless, and especially well borne 
by the stomach. It is given in a powder, a capsule, 
and an emulsion. 

Benzoin. — Benzoin is a solid balsam. All balsams 
contain three antiseptic principles, a volatile oil and 
two acids, benzoic and cinnamic. The liquid balsam 
of Tolu is similar to benzoin in its effect but it is so 
weak that its value in syrups is chiefly as a vehicle. 
The Compound Tincture of Benzoin, the form usually 
used, is administered by inhalation from a croup 
kettle or a pitcher of boiling water to which one tea- 
spoonful has been added. 

Oil of Eucalyptus. — The oil of eucalyptus is one of 
the strongest of the antiseptic oils. Eucalyptus trees 



RESPIRATORY ANTISEPTICS 175 

are native to Australia but are being cultivated exten- 
sively in California. Their roots grow to such a depth 
that they serve as drainage to the land; the leaves 
are so antiseptic that they purify the soil in malarial 
districts. The oil and eucalyptol, a derivative of it, 
are almost specific in diseases of the chest. They are 
administered by inhalation with steam or by an 
atomizer. Camphor and menthol are frequently 
combined with them. 

Respiratory Demulcents. — Respiratory demulcents 
protect irritated surfaces from contact with the air 
and thus check coughing. Such substances must be 
taken by mouth and reach only the upper air passages. 
They may spread to some extent over areas which they 
do not touch when swallowed. These drugs are 
medicinally inert and can be taken freely. The simplest 
demulcent is simple syrup, a dense solution of sugar. 
Another is syrup of acacia (gum arabic), a gum much 
used in pharmacy in making emulsions and pills. 
The mucilage of sassafras and the mucilage and troches 
of slippery elm are simple remedies made from common 
trees of the United States. The latter is the inner 
bark of a species of elm called Red Elm. 

Another popular demulcent is licorice, the botanical 
name for which is glycyrrhiza. Glycyrrhiza is a 
native shrub of Europe, and it is estimated that about 
100,000,000 pounds of its root or a pure extract are 
exported to the United States annually. The familiar 
black licorice sticks are the pure extract. More than as 
a respiratory demulcent this drug is used as a pleasing 
vehicle for other medicines. The Compound Licorice 



176 RESPIRATORY SYSTEM 

Powder, U. S. P., a cathartic mixture, owes its activity 
to sulphur and senna. 

Expectorants. — Expectorants are medicines which 
increase and fluidify bronchial mucus, thus facilitating 
its removal. They are usually given in the early 
stages of pharyngitis, laryngitis, bronchitis, and 
pneumonia to relieve a dry congestion. Some writers 
classify them as stimulating or depressing, referring 
to their effect on the general condition of the patient. 
There is no uniformity in their method of action. 

The common expectorants are ammonium chloride 
and carbonate, the iodides, terpin hydrate, apomorphine. 
ipecac, tartar emetic, and squill. 

Nauseating Expectorants.— The last four drugs 
named above are called nauseating expectorants because 
they act by creating a slight nausea and in large doses 
they cause vomiting. Apomorphine is an alkaloid 
derived from morphine by dehydration. It is given 
as an expectorant in doses of ^\ to ^V of a grain (0.001- 
0.002 Gm.). Ipecac (ipecacuanha) is a root drug from 
Brazil. The drug is expensive because it causes a 
pustular rash on the hands of the native collectors 
and they will not gather it if they can find anything 
else to do. Ipecac is almost never given now as an 
emetic and is being used less and less as an expectorant. 
The common preparations are the syrup, dose 4 minims 
(0.25 Cc.) and the wine, dose 10 minims (0.6 Cc). 
Tartar emetic, a popular name for antimony and potas- 
sium tartrate, has fallen largely into disuse because 
it tends to cause general depression. It enters into 
some expectorant mixtures which, on account of the 



RESPIRATORY ANTISEPTICS 177 

depressing effect of this ingredient, should be used 
with caution. Two of these mixtures are the Com- 
pound Licorice Mixture (Brown Mixture) which con- 
tains paregoric as well as tartar emetic (in the form of 
wine of antimony) and the Compound Syrup of Squill 
(Coxe's hive syrup). Patients who are taking either 
of these mixtures should be watched for symptoms of 
depression. Squill (scilla) is given in the form of the 
syrup and the compound syrup mentioned above. The 
syrup is made from the vinegar of squill, a preparation 
in which the drug is extracted with acetic acid. The 
dose is 30 minims (2 Cc). 

Stokes' expectorant, a National Formulary prepara- 
tion, contains squill, senega, ammonium carbonate and 
paregoric. 

Ammonium Compounds. — Of the two ammonium 
compounds, ammonium chloride and carbonate, the 
chloride is the more important as an expectorant. 
In congestion of the throat it acts as an astringent 
and increases the saliva by salt action. In such cases 
it is taken in the form of tablets or troches which are 
dissolved in the mouth. For medication of the larynx 
and bronchial tubes it is inhaled. There is a special 
apparatus in which the salt is made by mixing the two 
gases, hydrochloric acid and ammonia. The same 
results are obtained by placing near together two open 
dishes containing solutions of these gases. (This can 
be demonstrated by holding together the mouths of 
bottles which contain solutions of the gases.) Am- 
monium chloride is a common ingredient in cough 
mixtures. The dose is 5-15 grains (0.3-1 Gm.). 
12 



178 RESPIRATORY SYSTEM 

Iodides. — The use of iodides as expectorants is largely 
empirical. Sodium and potassium iodide are given in 
average doses of 10 grains (0.6 Gm.). They should 
never be given in tubercular cases, for there is strong 
evidence that they interfere with the formation of new 
tissue. They relieve chronic bronchitis and emphysema 
in asthmatic patients, probably by their salt action. 
(For further description of the iodides, see page 211.) 

Terpin Hydrate. — Terpin hydrate is a derivative of 
the oil of turpentine which has now largely displaced 
the oil for internal use. It is given as a powder or in 
capsules in doses of 2 grains (0.1 Gm.). 



CHAPTER XV. 
DIGESTIVE SYSTEM. 

Most drugs which affect the digestive system act 
directly on the walls of the alimentary canal. A few 
act through the nervous system. There is none in 
use which has any known effect on the pancreas and 
only one or two which act on the liver. 

The common affections resulting directly from dis- 
orders of the digestive system are gastric and intes- 
tinal indigestion, emesis, loss of appetite, infections, 
excessive flatulence, constipation, diarrhea, jaundice, 
diabetes, headaches, and auto-intoxication. In the 
prevention and treatment of such disorders more and 
more emphasis is being put on diet and hygienic living. 
Overeating, eating in haste, eating too rich foods, 
eating during extreme nervous fatigue or excitement, 
irregular meals, lack of physical exercise, eye-strain, 
mental depression, are all common causes of digestive 
disorders. 

The drugs which act on this system are acids and 
alkalies (see Chapter VIII) and the following classes: 

Class of drugs used for effect in mouth . . sialagogues. 

emetics. 



Classes of drugs used for effect in stomach 



Classes of drugs. used for effect in intestines 



antiemetics. 

digestants. 

absorbents. 

stomachics. 

antiseptics. 

carminatives. 

cathartics. 

antidiarrheics. 

anthelmintics. 



180 DIGESTIVE SYSTEM 

EFFECT IN THE MOUTH. 
Sialagogues. 

Sialagogues are medicines which increase the flow 
of saliva. They are indicated in fevers to relieve thirst 
and usually consist of fruit acids given in the form of 
orangeade, lemonade or grape-juice. Their effect is 
largely due to salt action and direct stimulation of the 
secreting cells. 

EFFECT IN THE STOMACH. 

Emetics. 

Emetics are medicines given to produce vomiting 
(emesis). Warm water, with or without salt (2 to 4 t. to 
a glass of water), is the best simple emetic given by 
mouth, and apomorphine, dose gr. ^o (0-006 Gm.), 
the only available one for hypodermic injection. 
Warm water or saline given by mouth before apo- 
morphine aids its action. A teaspoonful of mustard 
in warm water is an effective emetic if the mustard is 
fresh and the ivater not too hot, but it should not be used 
if the stomach is in an irritated condition. The 
latter is true of powdered ipecac, which may be given 
in doses of 15 grains (1 Gm.) in warm water. Copper 
and zinc sulphate are dangerous emetics if there is any 
abrasion on the stomach wall as they may be absorbed 
and cause general depression. When used they are 
usually administered in small doses at frequent intervals 
until 7 grains (0.5 Gm.) of copper sulphate and 30 grains 
(2 Gm.) of zinc sulphate are given or emesis produced. 



EFFECT IN THE STOMACH 181 

Antiemetics. 

Antiemetics, as the name implies, are given to check 
emesis. As the cause of emesis is usually a local 
irritation of the lining of the stomach or a stimulation 
of the vomiting centre, the treatment is to remove the 
local cause by emetics and cathartics, to soothe any 
subsequent irritation, and to depress the vomiting 
centre by morphine. The first method may be suffi- 
cient in some cases; in others all have to be tried. If 
emesis is due to excessive acidity, lime-water or sodium 
bicarbonate are indicated for neutralization; if due to 
excessive irritability, the treatment may be counter- 
irritants, an ice-bag over the gastric region, bismuth 
to coat over the surface, or cocaine to paralyze the 
sensory nerve endings. It is known by experience 
that champagne and carborated drinks are effective 
in postoperative vomiting, probably because of the 
slight stimulating action of carbon dioxide gas. Cerium 
oxalate is a remedy which is usually tried in the vomit- 
ing of pregnancy, and is often given in combination 
with sodium bicarbonate. Its action is purely mechani- 
cal like that of bismuth. Probably much larger doses 
than are usually given are required to obtain good 
results. The usual dose is about 5 grains (0.3 Gm.). 

Digestants. 

Digestants are animal or vegetable ferments given 
to supplement the action of the natural digestive 
ferments. The importance of this class of medicines 
has much decreased in late years for it has been 



182 DIGESTIVE SYSTEM 

proved that only in rare cases of atrophy of the mucous 
membrane are the natural ferments decreased in 
quantity. 

Pepsin. — Pepsin, a protein digesting ferment derived 
from the stomach of swine, acts only in a mildly acid 
medium and is often given in combination with hydro- 
chloric acid. Papain is a vegetable ferment resembling 
pepsin. Papayan tablets, a proprietary remedy for 
indigestion, were advertised to contain papain, but 
they consist chiefly of sodium bicarbonate and charcoal. 

Pancreatin. — Pancreatin, a mixture of pancreatic fer- 
ments also derived from swine, acts only in an alkaline 
medium and, as it is destroyed in the stomach, it has 
no effect on intestinal digestion. It is sometimes given 
with sodium bicarbonate for the same disorders as 
are treated by pepsin and hydrochloric acid. The 
chief therapeutic use of pancreatin is to predigest or 
peptonize milk. Pepsin cannot be used for this purpose, 
as it always contains mixed with it some rennin which 
coagulates the milk. It has been proved beyond a 
doubt that pepsin and pancreatin, when mixed together 
in solution, destroy each other. There are, however, 
well-advertised and widely used proprietary "digestive 
tablets" which contain these two ferments alone or 
in combination with diastase and one or more acids. 
These mixtures are typical " shotgun" prescriptions 
the use of which is wholly irrational and unscientific. 

Diastases. — Diastase is a starch-digesting ferment 
of barley malt. Taka-diastase, similar to diastase 
in action, is derived from a mold of the rice-plant in 
Japan. The diastases are on the market in numerous 



EFFECT IN THE STOMACH 183 

forms, as maltine, maltzyme, panase, diazyme essence, 
and extracts of malt. The claims of the manufacturers 
as to the digestive powers of these remedies should be 
taken with reservation. Preparations of taka-diastase 
lose their digestive powers with age. 

Absorbent. 

Charcoal. — Animal charcoal is a simple drug which 
has the property of absorbing gases. Such a remedy is 
known as an absorbent. As charcoal loses its ab- 
sorptive power when wet, its administration is 
irrational except in capsules. Charcoal tablets should 
not be chewed or allowed to dissolve in the mouth. 
Even if this drug reaches the stomach dry it soon is 
moistened in the juices and rendered inert. Charcoal 
is sometimes given in large amounts in cases of acute 
poisoning by arsenic, alkaloids and other drugs in the 
hope that the poison will be absorbed from its solution 
and made harmless. 

Stomachics. 

Method of Action (see Fig. 11, page 138). — Stomachics 
are medicines which improve the appetite and diges- 
tion chiefly by stimulating the taste organs. It is a 
well-known fact that the taste, the smell or even the 
thought of food of which a person is particularly fond 
will cause an increase of the amount of saliva in the 
mouth. The expression is that " it makes the mouth 
water." At the same time reflex stimuli from the mouth 
start the flow of gastric juices. The reflex stimuli 



184 DIGESTIVE SYSTEM 

depend largely on the taste buds located on the back of 
the tongue. If for some reason these organs are not 
functioning properly, food is not relished and if taken 
is not well digested. In such cases stomachics are 
indicated. This class of drugs probably exerts also 
some direct stimulation on the gastric secreting cells. 
Some are slightly antiseptic and if taken over long 
periods tend to inhibit ferment action and thus derange 
digestion. The bitter taste of a stomachic is the prop- 
erty upon which its action depends; hence if this is 
disguised to make the potion more palatable its value 
is lost. They should be taken about half an hour 
before meals. 

Drugs. — The most important drug of this class is 
gentian, usually given in the form of a compound 
tincture of gentian. This preparation contains another 
stomachic, bitter orange, and a carminative, cardamom. 
Gentian enters into many tonics for the appetite. 
It is a root drug which comes chiefly from Europe. 
All bitters are very old medicines and this one is said 
to have been named from Gentiana, a king living in 
the second century before Christ, who first discovered 
its medicinal properties. Other stomachics are sweet 
flag (calamus), calumba (a root used as a panacea in 
East Africa), dandelion (taraxacum), and quassia, 
the wood of a tree native in Jamaica. These drugs 
are used in the form of tinctures, dose 1 dram (4 Cc.) 
and very frequently in home-made infusions, dose 
1 to 2 fluidounces (30 to 60 Cc). Quinine, cinchona, 
and nux vomica, because of bitter properties, are of 
some value as stomachics. 



DRUGS WHICH ACT OX THE INTESTINES 185 

DRUGS WHICH ACT ON THE INTESTINES. 

Antiseptics. 

The common intestinal antiseptics are guaiacol 
and creosote carbonates (see page 174), calomel and 
salol. It is a question if any antiseptic is of much 
value in intestinal infections, but salol is probably 
the best. Salol (phenyl salicylate) breaks down in 
the intestines and liberates the two antiseptics from 
which it is made, phenol and salicylic acid (see Fig. 9, 
page 128). These decomposition products are absorbed 
and excreted in the urine, coloring it dark and acting 
to some extent as a urinary antiseptic. Salol is also 
used for the same purpose as phenacetine and often 
in combination with it. The dose is 3-8 grains (0.2-0.5 
Gm.) preferably administered in capsules. As salol 
contains 40 per cent, of phenol, which is a powerful 
depressant, this drug must be used with some care. 

Carminatives. 

Action. — Carminatives are medicines given to assist 
in the expulsion of gas from the alimentary canal. 
Their action is twofold: they are antiseptic to the 
organisms which cause the gas and by a slight stimula- 
tion cause its expulsion without affecting the solid 
content of the stomach or bowel. Most carminatives 
owe their activity to a volatile oil. 

Source of Gas. — One often wonders at the excessive 
quantities of gas sometimes present in the alimentary 
canal. Babies and neurotic patients swallow con- 



186 DIGESTIVE SYSTEM 

siderable amounts with food. It is probable that 
the natural interchange of gases in the tissues is dis- 
ordered in neurotics and abnormal amounts are 
excreted into the alimentary canal. Another source, 
and a frequent one, is the elimination of excessive 
amounts of hydrogen gas from the fermentation of 
carbohydrates, the digestion of which has been delayed. 
Hydrogen is very slowly absorbed, 'hence accumulates 
and causes flatulent colic. As prophylactic measures 
there should be thorough mastication of food, no 
fluid just at the beginning of the meal, a restriction of 
carbohydrates and an elimination of sugar in the diet. 
Drugs. — The drugs which are commonly used as 
carminatives are the oil of peppermint, cardamom, 
asafetida, oil of turpentine, myrrh, camphor, and capsicum. 
Oil of peppermint, one of the few drugs produced in 
large amounts in this country, is usually administered 
in the form of the spirit or essence of peppermint in hot 
water or in the form of lozenges. The dose of the 
spirit is 30 minims (2 Cc). Cardamom, the fruit of a 
reed-like plant in India, is official as a tincture and 
compound tincture, the dose of each being 1 dram (4 Cc). 
Asafetida (see page 143) and oil of turpentine are used 
as carminatives mostly by enema, \ ounce (15 Cc.) 
of the latter being given in 6 ounces (180 Cc.) of oil or 
1 pint (JL.) of soapsuds. Myrrh, a gum resin, is seldom 
used alone but in combination with cathartics. It is 
frequently added to gargles and mouth washes for an 
astringent action. Capsicum, a common name for 
which is cayenne pepper, is used in the form of the 
tincture, dose 7 \ minims (0.5 Cc). 



DRUGS WHICH ACT ON THE INTESTINES 187 

Cathartics. 

Cathartics are medicines given to cause an evacuation 
of the bowels. Diet and exercise are most important 
factors in regulating catharsis. One or more glasses 
of cold water on rising, followed by a few abdominal 
or general exercises, for most people will ensure a 
regular evacuation. As a common cause of constipation 
is lack of fluids from two to four pints of water should 
be taken daily as a prophylactic. Laxative foods are 
green vegetables, coarse breads, . fruits, especially 
apples, pears, and oranges, dried fruits, such as figs, 
prunes and dates, honey, molasses and oatmeal. 

Action. — Most cathartic drugs owe their activity to 
some irritant active principle. They are usually given 
by mouth but they act only on the intestines because 
their active principles are not liberated until after 
they leave the stomach. The important factors to be 
considered in regard to cathartics are their degree 
of action and the portion of the intestines affected. As 
a rule the degree of action depends upon the size of 
the dose, although some are too weak ever to exert 
more than a mild action. Cathartics are frequently 
classified on the basis of the degree of action as laxa- 
tives or aperients, those having a mild action, purga- 
tives, those causing full and free catharsis and drastics, 
those very severe in action. They will be considered 
first according to the part of the intestine upon which 
they act and then classified by the degree of action. 

On Duodenum. — A few cathartics act chiefly on the 
duodenum — calomel and other mercurials and podo- 



188 DIGESTIVE SYSTEM 

phyllum. As a result of the action of these drugs the 
contents of the duodenum is moved on and the increased 
bulk in passage through the intestines continues the 
peristalsis. To complete the evacuation these cathar- 
tics at times have to be supplemented by others which 
act on a lower part of the bowel. An evacuation of the 
duodenum opens a free passage for bile from the liver 
and the cathartics of this group are called cholagogues 
because of this secondary result. They do not, as was 
once believed, act directly on the liver. As biliousness, 
bilious headaches, and jaundice are often caused by 
absorption of bile and toxins which have accumulated 
in the duodenum these cathartics are indicated in 
the treatment of such disorders. Calomel (hydrargyri 
chloridum mite — mild mercurous chloride) is commonly 
administered in doses of y^ to J of a grain (0.006-0.02 
Gm.) at intervals of twenty to thirty minutes until 
1-3 grains (0.064-0.2 Gm.) are given. If a free evacua- 
tion is not secured within twelve hours a cathartic, pre- 
ferably a saline, is given to secure the desired result 
and to prevent the absorption of mercury. Mercury 
(hydrargyrum) itself is given in finely divided particles 
in the form of blue mass or pill and with chalk in the 
so-called Gray Powder. The dose of each is 4 grains 
(0.25 Gm.) which is equivalent to about 1J grains 
(0.1 Gm.) of mercury. Podophyllum, an American 
root drug, is sometimes spoken of as "vegetable 
calomel" because it has an action similar to that of 
calomel. The active principle of podophyllum is a 
resin called podophyllin and this is the form used as a 
medicine. The dose is from yo to § of a grain (0.003- 
0.03 Gm.) according to the degree of action desired. 



DRUGS WHICH ACT ON THE INTESTINES 189 

On Liver. — Certain drugs are reputed to act directly 
on the liver and cause an increase in the excretion of 
bile. These drugs are sodium glycocholate, sodium 
taurocholate, ox-gall, and several proprietary mixtures 
of bile salts. Recent experiments have proved them 
of doubtful value. 

On Small Intestines. — The cathartics which act 
on the small intestines are the oils, olive, croton and 
castor, and a group which, because their active prin- 
ciples are resins, are termed resinous cathartics. 

Oils. — Of the first class, olive oil (oleum olivse) is 
chiefly a lubricant and may be given in doses of 1 to 
2 tablespoonfuls one-half hour before meals for a very 
mild action. Croton oil (oleum tiglii), however, is a 
drastic used only in extreme cases. It is given in doses 
of 1 minim (0.06 Cc), one minim of this oil being 
equivalent to one drop. Croton oil is of special ad- 
vantage with the insane because of the smallness of 
the dose and the fact that good results can be obtained 
if it is merely dropped on the tongue. It may be given 
on sugar or a piece of bread. Castor oil (oleum ricini) 
except for its taste is one of the most satisfactory 
cathartics in medicine. Its dose is 4 fluidrams (16 Cc.) 
and it acts in from two to six hours. Its taste is dis- 
guised in a variety of ways, the purpose of all being 
to get the oil down the throat without its coming in 
contact with the taste organs. It should be prepared 
in a small glass to reduce as much as possible the chance 
of contact with the lips. The usual method is to place 
the oil between two layers of some aromatic liquid, 
such as orange juice. Another palatable method of 



190 DIGESTIVE SYSTEM 

preparing this oil is to fill a glass with a foaming 
flavored carbonated water, then pour the oil into the 
middle of it. The whole must be taken at once. Chil- 
dren sometimes take castor oil alone without objection. 
If they will not, it may be prepared for them in the 
form of a syrup. Castor-lax and risiccol are two 
preparations on the market in which the oil is in 
a powder form. Castor oil is best taken before 
breakfast. 

Resinous Cathartics. — The resinous cathartics are 
elaterin, jalap, colocynth, gamboge, and scammony. 
The first two are the only ones much used alone: all 
except the first are ingredients of Compound Cathartic 
Pills. These are all highly irritating, should never 
be given to children or to pregnant women, and, if 
given over a continued period, tend to cause constipa- 
tion. Elaterin is the most powerful drug known for 
the production of watery stools. Such a cathartic is 
called a hydragogue and has special use in dropsy and 
uremia. It is likely to be followed by a general depres- 
sion from the excessive loss of fluids. Its dose is yq 
of a grain (0.006 Gm.). The triturate is official, dose 
\ grain (0.03 Gm.). The resin of jalap and a Com- 
pound Jalap Powder are official. The dose of the former 
is 2 grains (0.1 Gm.); of the latter, 30 grains (2 Gm.). 

On Colon. — The cathartics which act chiefly on the 
colon are phenolphthalein and the familiar ones, senna, 
cascara, rhubarb, and aloes. The last four of these 
drugs owe their activity to derivatives of anthracene, 
a hydrocarbon obtained from coal tar, and they 
are often spoken of as the anthracene cathartics. 



DRUGS WHICH ACT ON THE INTESTINES 191 

Phenolphthalein (see Fig. 9, page 128) is a white 
powder which in an alkaline solution, such as SQapy 
water, produces a red color. Its cathartic properties 
were discovered as a result of its use as a dye in red 
wines. Its dose is from 1 to 8 grains (0.06 to 0.5 Gm.). 

Senna leaves are much used for home-made infusions 
and they enter into the composition of numerous 
cathartic preparations. The Compound Infusion of 
Senna (Black Draught) contains also Epsom salts. 
Its dose is 2 ounces (60 Cc.) and it acts in about four 
hours. Senna is the active ingredient in Compound 
Licorice Powder, Syrup of Figs, a chocolate-coated 
confection called Tamar Indien, and many other 
proprietary laxatives. 

Cascara sagrada (Rhamnus Purshiana) is a medicinal 
bark from small trees grown on the Pacific coast. The 
trees are killed by the barking, approximately 200,000 
trees being destroyed annually to supply the world's 
trade. The name of this drug is Spanish, meaning 
sacred bark, and it is said to have originated from the 
first use of the medicine by monks. Cascara seems to 
produce the nearest to a natural action of the bowels 
of any of the cathartics and is the best for a continued 
administration. The aromatic fluidextract and the 
extract are the commonly used preparations, the dose of 
the former being 10-30 minims (0.6-2 Cc). The latter 
is used in pills. They are best taken at bedtime. 

The medicinal rhubarb plant resembles our common 
garden pie-plant but is a larger species grown in China. 
There is record of its use in that country in 2700 B.C. 
Besides the cathartic principle of rhubarb, which 
predominates in ordinary preparations, it also contains 



192 



DIGESTIVE SYSTEM 



tannin which tends to cause a subsequent constipation. 
There are many preparations of rhubarb (rheum). 




Fig. 17. — Cascara sagrada. Five-year-old tree. From U. S. 
Bulletin 139, American Medicinal Barks. 



The aromatic tincture, dose 30 minims (2 Cc), and the 
aromatic syrup, dose 2 fluidrams (8 Cc), are much used 
and are best taken at bedtime. The Mixture of 



DRUGS WHICH ACT ON THE INTESTINES 193 

Rhubarb and Soda (this also contains ipecac as a mild 
beneficial irritant) is indicated in cases of indigestion 
rather than as a cathartic. 

Aloes, a highly irritating cathartic, is the dried 
juice of a cactus plant of East Africa. It increases 
the blood supply of the pelvic organs and if long 
continued tends to cause hemorrhoids. It should there- 




Fig. 18. — Aloes plant. Growing in the New York Botanical 
Garden, Bronx Park, New York City. 



fore never be used in pregnancy or when hemorrhoids 
already exist. A bedtime dose should be accompanied 
by some light food as this drug should never be 
taken on an empty stomach. The activity of aloes 
is due to aloin, a neutral compound which is less 
irritating than the crude drug and somewhat less 
active. Aloes is a good laxative but an undesirable 
13 



194 DIGESTIVE SYSTEM 

purgative because large doses cause severe griping. 
Belladonna is often combined with it to offset this 
action. The dose of aloes as a laxative is J to 1 
grain (0.03 to 0.06 Gm.) ; as a purgative, 2 to 5 grains 
(0.1 to 0.3 Gm.). The dose of aloin is 1 grain (0.06 
Gm.). This is sometimes used in very small doses to 
cure chronic constipation. Aloin is the cathartic 
ingredient of A. S. & B. Pills (aloin, strychnine and 
belladonna), also of Lady Webster's dinner pill. 

Enemas. — An enema may produce catharsis in three 
ways: (1) by increasing the bulk of the bowel content; 
(2) by lubricating hard feces in the lower bowel with 
olive oil, glycerin, or water; and (3) by an irritant 
action of ingredients in the enema such as strong 
soap or glycerin. 

On Whole Intestine. — Saline Cathartics. — The 
saline cathartics act upon the whole intestine and pro- 
duce catharsis by salt action as a result of which the 
intestinal wall is stimulated and the content of the 
bowel increased in bulk. The common salines are 
magnesium sulphate (Epsom salts 1 ), § ounce (15 Gm.); 
sodium phosphate, 30 grains (2 Gm.); and magnesium 
citrate, 6-12 ounces (180-360 Cc.) of the solution. 
They should be given about one-half hour before a 
meal, well diluted in cold water or followed by copious 
amounts of water to lessen the chance of absorption. A 
number of deaths have been reported from the absorp- 
tion of magnesium sulphate which had been admin- 
istered as a cathartic. If given as stated above the 
salines cause a free evacuation without pain in from one 

1 Named from Epsom, an English coast town, where it was first 
obtained. Its first source was sea weed. 



DRUGS WHICH ACT ON THE INTESTINES 195 

to two hours. If given concentrated, they are likely to 
produce nausea, griping, and general discomfort for 
several hours. A very mild laxative saline is a Seidlitz 
Powder, 1 the official name for which is Compound 
Effervescing Powder. The cathartic salt in this 
powder is potassium and sodium tartrate (Rochelle 
salt 2 ). Sodium bicarbonate and tartaric acid, the 
other ingredients, cause the effervescence and to avoid 
their interaction the powder is prepared in two papers; 
a blue paper containing the cathartic salt and sodium 
bicarbonate and a white paper the tartaric acid. 
When preparing a powder for administration the con- 
tents of the two papers are dissolved separately in 
water and the solutions mixed just before being given to 
the patient. If these powders have been long exposed 
to the air their effervescence is lost. 

Physostigmine. — In extreme cases of paralysis of the 
intestines, such as may occur after abdominal opera- 
tions, physostigmine salicylate is sometimes used, the 
probable action of which is to stimulate the muscular 
walls of the intestines. (See Fig. 11, page 138.) It 
is a marked central depressant and at times causes 
collapse. It is given subcutaneously in doses of 
eo of a grain (0.001 Gm.). 

Sulphur and Mineral Oil. — Two well-known mild 
cathartics which affect the whole intestine are sulphur 
and mineral oil. They both act by softening the bowel 
content and cause practically no irritation. Pure 
sulphur mixed with molasses and potassium bitartrate 



1 Named from a German apothecary who first made this prepara- 
tion. 

2 Named from the town of Rochelle, France, where it was first made. 



196 



DIGESTIVE SYSTEM 



(cream of tartar) is a household remedy, but more 
palatable preparations are tablets of sulphur and 
potassium bitartrate and the Compound Licorice 
Powder. Mineral oil is an oily petroleum product 
similar in composition to vaseline. Other names 
for this oil are Albolene or Russian oil and liquid 
petrolatum. It is of special use in chronic constipation 
and is given frequently in combination with a stronger 
cathartic like cascara. The dose is 1 ounce (30 Cc.) 
two or three times a day. 

Degree of Action. 

Cathartics may be classified roughly according to 
the degree of action as follows: 

Laxative: Sulphur, mineral oil, Seidlitz powder, compound licorice 
powder, olive oil, and the first four purgatives in small doses. 

Purgatives: Castor oil, calomel, podophyllin, mercury, jalap, 
physostigmine, phenolphthalein, and the anthracene group. 

Drastics: Purgatives in large doses, croton oil, and elate rin. 

Table of Cathartics. 





Approximate 




Cathartic. 


Time for 


Action. 


Time to be Given. 


Olive oil. 


12 


lours. 


Before meals. 


Croton oil. 


\~ 2 


" 


Before meals. 


Castor oil. 


2-6 


" 


Before meals. 


Elaterin. 


*-3 


" 


As ordered. 


Jalap. 


3 


" 


Before meals. 


Senna. 


10 -12 


" 


Bedtime. 


Comp. inf. of senna. 


4 


" 


Before breakfast. 


Rhubarb. 


10 -12 


<< 


Bedtime. 


Cascara. 


10 -12 


u 


Bedtime. 


Aloes. 


10 -12 


<< 


Bedtime. 


Salines. 


1-2 


" 


Before breakfast. 


Calomel. 


4-8 


" 


Bedtime or as ordered 


Mercury. 


4-8 


it 


Bedtime. 


Podophyllin. 


10 -12 


" 


Bedtime. 


Physostigmine. 


i-3 


11 


As ordered. 


Sulphur. 


10 -12 


" 


Bedtime. 


Mineral oil. 


12 


(« 


Two hours after meals 



DRUGS WHICH ACT ON THE INTESTINES 197 

Antidiarrheics. 

The name antidiarrheics explains the purpose of these 
drugs. In cases of diarrhea laxative foods must be 
avoided and fluids restricted. The foods which are 
most constipating are arrowroot or flour gruels, boiled 
milk, toasted crackers, rice and hard-cooked egg 
albumen. When diarrhea, such as the summer diarrhea 
of children, is due to excessive acidity in the alimentary 
tract, neutralization by alkalies is the rational remedy. 
Lime-water or sodium bicarbonate may be used or 
chalk, the alkaline carbonate of calcium, in the form 
of Compound Chalk Powder or Chalk Mixture. Chalk 
Mixture is a flavored mixture of the Compound Powder 
in water. It will keep not over a week and should be 
made fresh whenever wanted. The dose of the powder 
is 30 grains (2 Gm.); of the mixture, 4 drams (16 Cc). 

Bismuth acts as an antidiarrheic by forming a 
protective coat over the mucous membrane. This 
checks the secretions of the intestinal wall and prevents 
irritation by the bowel content. A black sulphide 
is formed which colors the feces black. The salts of 
bismuth commonly used in medicine are the sab- 
carbonate, subnitrate, and the subsalicylate. The dose 
of the subcarbonate is 1\ grains (0.5 Gm.), of the 
subnitrate 15 grains (1 Gm.), of the subsalicylate 4 
grains (0.25 Gm.). Bismuth enters into dusting 
powders for its protective and slightly antiseptic action. 
Dermatol, xeroform, bismal and others are new pre- 
parations of bismuth (see N. N. R.). For bismuth in 
Rontgentherapy, see page 301. 



198 DIGESTIVE SYSTEM 

Tannin (page 84) is an old remedy for diarrhea which 
has been practically displaced by bismuth. Oak and 
dogwood bark, chestnut leaves, yellow dock, black- 
berry leaves, sumach berries, kino, krameria, and 
numerous other drugs may be classed as antidiarrheics 
because of their tannin content. Tea and claret are 
constipating beverages. Hamamelis, the popular exter- 
nal remedy, contains tannin and is a weak astringent. 
The synthetic tannin compounds on the market are 
legion. 

Anthelmintics. 

Action. — Anthelmintics are drugs used to destroy 
worms of the gastro-intestinal tract. As these drugs 
are highly toxic and have to be given when conditions 
for absorption are at their best, the presence of worms 
must be determined beyond a doubt before the drugs 
are administered. The procedure in dealing with the 
tapeworm is first to lower its vitality by reducing the 
protein in the diet and by giving irritating foods. 
A fast of twelve to twenty-four hours is then prescribed 
and at the end a saline cathartic given. After free 
evacuation the anthelmintic is given on an empty 
stomach. These drugs only temporarily paralyze the 
worm and must be followed by a saline cathartic to 
carry it away. 

Description. — For tapeworm the remedy is aspidium 
(male fern) in the form of the oleoresin. The dose is 
regulated by the sex, age, and general condition of the 
patient. For round worms santonin is given, coarse 
crystals being preferred to a fine powder to lessen the 



DRUGS WHICH ACT ON THE INTESTINES 199 

danger of absorption. Often a simple cathartic will 
carry off ordinary pin- or threadworms. Calomel, 
lime-water, intestinal antiseptics and infusion of quassia 
are also given. As pinworms live mostly in the lower 
bowel, enemas of the infusion of quassia, common 
salt, \ ounce to 1 pint (15 Gm. to J L.), or turpentine, 
§— 1 ounce to 1 pint (15-30 Cc. to § L.), are given. 

The routine treatment in the United States for 
hookworm has been thymol given in small repeated 
doses. Thymol is a vegetable drug chemically allied 
to phenol and its iodide is known as aristol (page 236). 
It has recently been shown that oil of chenopodium 
is effective against hookworms. Chenopodium, a 
common weed know T n as American wormseed, has long 
been used as an anthelmintic against all intestinal 
worms and in the Orient it is preferred to any other 
drug in the treatment of hookworm. Three doses of 
the oil from 8-16 minims (0.5-1 Cc.) each are given 
at intervals on an empty stomach and the last dose is 
followed in two hours by castor oil. It is dangerous 
in excessive doses. 



CHAPTER XVI. 

EXCRETORY SYSTEM. 

The classes of drugs which act upon the excretory 
system are of two groups, those which affect excretion 
by the skin and those which alter the condition of the 
urinary organs. 

DRUGS WHICH ACT ON THE SKIN. 

Excretion by the skin may be increased (1) by 
stimulating the endings of the nerves which control 
the sweat glands or (2) by increasing the blood supply 
of the cutaneous vessels. It is diminished by creating 
an opposite effect. Drugs which increase the secretion 
of sweat are called diaphoretics (synonyms: sudorifics 
and hidrotics). Those which decrease it are the anhi- 
drotics. 

Diaphoretics. 

Diaphoretic measures are used chiefly to relieve the 
kidneys in nephritis and to remove edema in dropsy. 
They have some use in eliminating poisons and reducing 
fevers. Hot packs, hot baths, hot drinks, and vigorous 
exercise are diaphoretic agencies valuable under 
varying conditions. The last three are common remedies 
for the purpose of breaking up a cold. The object 



DRUGS WHICH ACT ON THE SKIN 201 

of each is to relieve a localized congestion by increasing 
the circulation and excretion of the skin. Hot packs 
are more extreme measures having the same purpose. 

Pilocarpine. — The one important diaphoretic drug 
is pilocarpine (see Myotics). Pilocarpine stimulates 
the endings of the same nerves affected by atropine, 
namely, those which do not pass through the sympa- 
thetic system, and it is used in therapeutics for its 
action on the eye and on the sweat glands. The pupil 
of the eye is contracted and the excretion of the sweat 
gland increased (see Fig. 11, page 138). The chief 
danger connected with the internal administration of 
pilocarpine is suffocation caused by excessive excretion 
in the bronchi. Large doses depress the heart. The 
salts used internally are the hydrochloride and the 
nitrate, the common dose being | of a grain (0.01 
Gm.). Doses as small as g 1 ^ of a grain (0.001 Gm.) 
are in some cases sufficient. 

Symptoms of overdosing by pilocarpine are con- 
tracted pupils, flushed face, wheezy, labored breathing, 
and a slow pulse. The treatment is hypodermic injec- 
tions of atropine, artificial respiration, and stimulants. 

Minor Diaphoretics. — Morphine in the form of 
Dover's Powder is a mild diaphoretic if given with 
hot drinks (see page 106). Ammonium acetate also 
has a mild diaphoretic action by dilating the periph- 
eral bloodvessels, and it slightly increases the flow of 
urine by salt action. It is a good remedy for children. 
The common preparation is the Solution of Ammo- 
nium Acetate, the adult dose being 4 drams (15 Cc). 
Basham's Mixture (page 165) is useful in chronic 



202 EXCRETORY SYSTEM 

nephritis because of the action of this drug on the kid- 
neys. The Spirit of Nitrous Ether, a solution of ethyl 
nitrite in alcohol, is a popular diaphoretic and diuretic 
in colds and fevers. It is frequently combined with 
ammonium acetate. Sweet Spirits of Niter is a popular 
name for this preparation. The dose is 30 minims (2 Cc.) . 

Anhidrotics. 

Local measures for decreasing the excretion of sweat 
are sponging in strong alcohol or in solutions of vinegar 
or alum. Internal remedies are indicated chiefly 
in the night-sweats of tuberculosis. The strongest 
anhidrotic for internal use is atropine. The disad- 
vantage of its use is the accompanying dryness of the 
throat. A drug similar in action is agaricin, an extract 
of a fungus of European larch trees. Its effect is 
fleeting but without the annoying side actions of 
atropine. Another anhidrotic is camphoric acid, 
an oxidation product of camphor. Night-sweats of 
tuberculosis are thought to be due to a slight asphyxia. 
Camphoric acid relieves this by stimulating the 
respiratory centre. It has a very disagreeable taste 
and is given in a capsule or cachet in doses of 15 grains 
(1 Gm.). 

DRUGS WHICH ACT ON THE URINARY ORGANS. 

The classes of drugs which are used for their action 
on the urinary organs are urinary antiseptics, diuretics, 
and antilithics. 



DRUGS WHICH ACT ON THE URINARY ORGANS 203 

Antiseptics. 

Urinary antiseptics are indicated in general septic 
conditions, in pyelitis (inflammation of the pelvis of 
the kidney), in cystitis, urethritis, and infections by 
organisms such as colon bacillus and gonococcus. 

Hexamethylenamine. — The drug most used under 
ordinary conditions as a urinary antiseptic is hexa- 
methylenamine (hexa-methylen-amine) . Some of the 
patented names for this drug are urotropin, formin, and 
ammoform. Hexamethylenamine is made by combin- 
ing formaldehyde and ammonia and its value is due to 
a liberation of these substances in the urine. It has 
been tried as an antiseptic for the respiratory tract and 
the cerebrospinal fluid but with doubtful results. In 
mild septic cases, such as in abscesses and feverish colds, 
it is reputed to relieve the systemic conditions. Hexa- 
methylenamine has no antiseptic effect on the urine 
unless the urine is acid in reaction. To ensure this acid 
condition sodium acid phosphate is frequently adminis- 
tered alternately with hexamethylenamine. The dose 
of hexamethylenamine is 5 grains (0.3 Gm.). Helmitol 
is a proprietary compound of hexamethylenamine and 
citric acid. 

Miscellaneous Drugs. — Other urinary antiseptics 
are salol, uva ursi, buchu, cubebs, oil of santal, and 
copaiba. Salol has already been studied (see page 185). 
The others all owe their activity to volatile oils. Uva 
ursi is a leaf drug, especially efficient against colon 
bacillus. The fluidextract, dose 30 minims (2 Cc), 
and the infusion are used. Buchu, another leaf drug, is 



204 EXCRETORY SYSTEM 

best given as an infusion. There are buchu tablets 
on the market which when dissolved in hot water 
make the equivalent of an infusion. Cubebs are small 
berries which contain a resin as well as a volatile oil. 
The oil and oleoresin are both used in doses of from 
5 to 20 minims (0.3-1.2 Cc). The oil of santal is 
distilled from santalwood (sometimes spelled sandal- 
wood). Its dose is 8 minims (0.5 Cc). Arheol, Carbo- 
sant, Santyl, and Thyresol are trade names of chemical 
derivatives of this oil which are claimed to be less 
irritating to the gastro-intestinal tract than the oil 
itself. Copaiba is an oleoresin sometimes incorrectly 
called balsam of copaiba. It is excreted by the bronchial 
mucous membranes, the kidneys, and the skin. Its 
excretion through the skin sometimes causes eruptions ; 
its passage through the bronchial membrane makes it 
an expectorant. Its greatest use, however, is as a 
urinary antiseptic. It is given in capsule or in an 
emulsion in doses of 15 minims (1 Cc), and frequently 
with the spirit of nitrous ether, cubebs, or the oil of 
santal. Uva ursi, cubebs, and copaiba are all used 
as antiseptics in gonorrheal infections of the bladder 
and urethra. 

Diuretics. 

Diuretics are drugs which cause an increase in the 
flow of urine. They may do this in four ways: 

1. By direct stimulation of the secreting cells. 

2. By irritation of the secreting cells. 

3. By improving the circulation of the glomeruli. 

4. By decreasing resorption of fluids from the tubules. 



DRUGS WHICH ACT ON THE URINARY ORGANS 205 

Briefly stated the solids of the urine are excreted 
chiefly by the cells lining the tubules. The fluids are 
exuded chiefly from the blood as it passes through the 
glomeruli and these fluids in flowing through the 
tubules wash down the excreted solids. 

1. Stimulation. — Caffeine (page 93) and theobro- 
mine produce diuresis by pure stimulation without 
irritation. Theobromine is an alkaloid closely allied to 
caffeine and it has a similar action on the kidneys and 



Glomerulus 



Blood 
stream 




To pelvis of kidney 
Fig. 19. — Schematic diagram of kidney tubule. 

the heart without such marked stimulant effects on the 
central nervous system. It is of special value in dropsy. 
It is derived from cacao nuts or shells or made syn- 
thetically. 1 The medicinal salts of this alkaloid are 
theobromine sodium salicylate (diuretin) and theo- 
bromine sodium acetate (agurin). The purpose of the 
sodium salt in these compounds is to make them more 

1 Cacao nuts also yield chocolate and cocoa which should be called 
cacao. Cocoanut trees yield cocoanuts. Coca plants yield cocaine. 



206 EXCRETORY SYSTEM 

soluble. Theophyllin (trade name, theocin), a similar 
synthetic diuretic, is more powerful than theobromine 
but less permanent in action. Theobromine and 
theophyllin tend to produce gastric disturbances and 
are given in capsules or well diluted in water. The 
dose of theobromine is about 7 J grains (0.5 Gm.), 
of theophyllin about 4 grains (0.25 Gm.), given in 
warm tea. 

Theobromine is sometimes given in the form of 
cocoa, a cup of the best cocoas containing about 
1J gr. (0.08 Gm.) of the drug. 

2. Irritation. — The irritant diuretics are calomel and 
the urinary antiseptics already studied, buchu, oil of 
santal, cubebs, copaiba, and uva ursi. Calomel is of 
special use in cases of cardiac dropsy; the others when 
infections are present. There are a few drugs used 
externally which may be absorbed and cause irritation 
of the kidneys. They are oil of turpentine, cantharides 
and capsicum, common counter-irritants, and chryso- 
robin (Goa powder) used in skin diseases (page 248). 
Any sign of kidney irritation during treatment by these 
drugs should be reported immediately. 

3. Improvement of Circulation. — Digitalis and stro- 
phantus act as diuretics in dropsical conditions by 
improving the circulation. They are often given with 
caffeine. Water taken freely will cause diuresis by in- 
creasing the volume of the blood in the kidney. Pituitary 
extract produces the same result by causing vasocon- 
striction except in the kidneys. Certain salts increase 
the volume by salt action. Among the best diuretic 
salts are potassium acetate, dose 30 grains (2 Gm.), and 



DRUGS WHICH ACT ON THE URINARY ORGANS 207 

potassium citrate, dose 15 grains (1 Gm.). Others are 
the bicarbonates of sodium and potassium, potassium 
bitartrate (cream of tartar), and ammonium acetate 
in Basham's mixture. As these are all alkaline salts 
they are especially useful when there is excessive acidity 
of the urine. 

4. Prevent Resorption. — It is probable that one cause 
of a diminished flow of urine is resorption of fluids 
from the tubules. This may be checked by a rapid 
flushing of the tubules and by a salt-free diet. One 
theory upon which this diet is based is that chlorides 
become stored in excess in. the cells of the kidneys. 
To keep this excess properly diluted water is absorbed 
from the tubules. When sodium chloride is withheld 
from the diet the available source for storage is dim- 
inished and some of the excess may pass from the cells 
to bring the circulating fluids to a proper degree of 
concentration. 

Antilithics. 

Another disorder of the urinary system is the presence 
of calculi (stones). They are composed of uric acid, 
oxalate of lime, phosphates, and other organic com- 
pounds which normally are in solution in the urine. 
Some calculi are small enough to be passed in the 
urine, otherwise surgery is practically the only known 
treatment. The term, antilithics, is applied to medi- 
cines used in an attempt to dissolve stones in the 
kidney or bladder. Uric acid calculi tend to form in 
too acid urine, and alkaline salts such as potassium 
acetate and citrate may prevent further increase in 



208 EXCRETORY SYSTEM 

their size and possibly break up loosely formed ones. 
Phosphatic calculi are favored by too alkaline urine 
and inorganic acids may be of similar benefit in such 
cases. There is extensive advertising of mineral waters 
for the prevention and solution of stones, but they are 
mainly if not wholly without value. 



CHAPTER XVII. 
DRUGS WHICH AFFECT NUTRITION. 

The processes of nutrition are dependent primarily 
on the nervous system, and any measures, hygienic 
or therapeutic, which improve that system improve 
nutrition. Another important factor in nutrition is 
a normal supply of the food principles necessary to the 
cells. A deficiency may be due to poor diet or, if the 
diet is well balanced, to incomplete absorption or 
assimilation. The whole problem is a very complex 
one and little is known of the action of drugs on nutri- 
tive processes. 

Phosphorus. — As phosphorus is a necessary con- 
stituent of nerve tissue, it has been employed in medi- 
cine as a nerve tonic. The fact that fish contains 
a comparatively large amount of phosphorus has given 
rise to the theory that fish is a brain food. 

Action. — Phosphorus in the form of hypophosphites 
has been much used as a general tonic but it has now 
been proved beyond a doubt that all the hypophos- 
phites taken by mouth are excreted unchanged, hence 
can have no possible systemic effect. The various 
syrups of hypophosphites owe their usefulness to other 
ingredients, such as strychnine, iron, and arsenic. 
Glycerophosphates were introduced as substitutes for 
14 



210 DRUGS WHICH AFFECT NUTRITION 

the phosphites, but there is no proof that they are 
any better. Lecithin is the compound of phosphorus 
which occurs in most living cells, especially nerve and 
brain cells, and it is one of the constituents of milk 
and eggs. This has been obtained pure and marketed 
as a stimulant to nutrition. An ordinary diet contains 
from 75 to 225 grains (5 to 15 Gm.) of lecithin, and 
probably a diet rich in milk and eggs would be as 
efficient as lecithin taken as a medicine. Phosphorus 
aids in the nutrition and growth of bone-marrow and 
bone cells. This results in some increase in the number 
of red corpuscles. It may be given in pills contain- 
ing Y25 °f a grain (0.0005 Gm.) of the drug, or in 
phosphorated oil 1:100. 

Toxicology. — Large doses or continued local contact 
with phosphorus cause necrosis of the bone, known 
among match factory workers as "phossy jaw." 
Through the magnanimity of the Diamond Match 
Company in making public their process of using 
non-poisonous phosphorus and by stringent legislation 
this disease is being eliminated in industry. The 
chemical antidotes for phosphorus are potassium 
permanganate and copper sulphate. Oil should be 
avoided in cases of poisoning as it increases the ab- 
sorption of the drug. 

Calcium. — Calcium is a normal constituent of the 
body the lack of which causes soft bones, possibly 
excessive permeability of the bloodvessels and nervous 
conditions such as tetany, convulsions, and epilepsy. 
This drug is being very much studied at the present 
time. When given by mouth it is absorbed slowly 



IODIDES 211 

and in small amounts. Calcium chloride, lactate/ and 
hypophosphate are given by mouth and attempts 
are being made to find a suitable salt and method for 
subcutaneous injection. 

Iodides. — The iodides are considered in this class 
of medicines because they have the power of favorably 
modifying cellular activity. They are frequently and 
correctly called " alteratives." They have the following 
uses in therapeutics: 

1. In tertiary syphilis (see page 219). 

2. In arterial diseases resulting from syphilis. 

3. In emphysema and chronic bronchitis as ex- 
pectorants (see page 177). 

4. In aneurysm of the aorta, arteriosclerosis, and 
other cases of high arterial tension. 

5. In some forms of goitre. 

6. In certain infectious diseases in which exudates 
form in the tissues. 

7. In cases of poisoning by the heavy metals such as 
lead and arsenic. 

Action. — Practically all the diseases above mentioned 
are characterized by the formation of some kind of 
exudates or abnormal cells and the iodides cause these 
to disappear. The value of the iodides has long been 
established but their method of action is still not 
understood. It has been suggested that these disorders 
may be caused by a deficiency of the internal secretion 
of the thyroid gland which contains iodine, and that the 
iodides are remedial by stimulating that gland. Other 
explanations are that the beneficial cellular changes are 
due to the presence in the cells of free iodine liberated 



212 DRUGS WHICH AFFECT NUTRITION 

from the iodide, or to the formation of some ferment 
which destroys the abnormal formations. 

Dosage. — The iodides of potassium and of sodium are 
the ones commonly used. For non-syphilitic treatment 
they are given in doses of from 5 to 30 grains (0.3-2 
Gm.). Often saturated solutions are used, 1 minim 
of which is equivalent to one drop and contains 1 
grain of the iodide. A course of iodides is begun with 
a dose of about 5 drops and increased daily. Iodides 
should not be given on an empty stomach. The com- 
mon method of their administration is in or with milk. 
If in tablet form the tablets must be dissolved before 
they are swallowed. By whatever method given the 
iodides must be icell diluted. To prevent the metallic 
taste often present in the mouth during a course of 
iodides, a gargle of sodium bicarbonate may be used. 

Toxicology. — The untoward actions of the iodides 
produce a condition spoken of as "iodism." It is 
characterized by coryza, salivation, and skin eruptions. 
An important preventive measure is extreme cleanliness 
of the skin and mucous membranes. 

Thyroid Gland. — Action. — Thyroid gland is a true 
stimulant to metabolism. The official preparation, 
Desiccated Thyroid Glands, obtained from sheep, is a 
yellowish powder. It is now an extablished fact that 
the activity of any thyroid gland preparation runs 
parallel with the amount of iodine contained in it. 
The commercial standard requires an iodine content of 
not less than 2 per cent. Therapeutic doses of this 
medicine cause an increase in the katabolism of fat 
and protein and a corresponding loss of weight. For 



REMEDIES FOR HYPERTHYROIDISM 213 

this reason it has been used to reduce obesity. Its 
results are not permanent and unless protein is very 
much increased in the diet it tends also to reduce 
strength. Beneficial results have been reported from 
the use of thyroid gland in marasmus, rickets, soften- 
ing of the bones, delayed union of fractures, and in 
other diseases characterized by disordered nutrition. 
The greatest use of thyroid gland in therapeutics is 
to supply thyroid secretion when the gland has been 
removed or is atrophied and in two diseases, myxedema 
and cretinism, caused by inactivity of the gland. 

Dosage. — Medication is usually started in doses of 
1 grain (0.06 Gm.), three times a day, and gradually 
increased. During the administration the patient 
should avoid exertion and have a diet rich in protein. 
There is on the market a triturate of the active prin- 
ciples of the thyroid gland called iodothyrin or thyro- 
iodine but results from its use have been variable. 

Remedies for Hyperthyroidism. — By hyperthyroid- 
ism is meant excessive activity of the thyroid gland 
such as occurs in exophthalmic goitre. A theory has 
been advanced that the thyroid gland secretes certain 
toxins which in normal animals are neutralized by other 
substances in other parts of the body. If then, on this 
theory, the glands be removed from an animal, the 
neutralizing substances will accumulate in the blood 
and this blood will act as an antidote in other animals 
suffering from hyperthyroidism. There are in use 
two preparations from the blood of sheep from which 
the thyroids have been removed, antithyroidin- 
Moebius and thyreoidectin. Another remedy is 



214 DRUGS WHICH AFFECT NUTRITION 

Beebe's serum, a serum from animals which have been 
immunized against thyroid. 

Antipyretics. — One of the products of nutritive 
processes is heat, and when the cellular or central 
mechanisms are so deranged as to cause excessive heat 
production or to prevent sufficient heat loss a condition 
results which is called fever. Any measures, nursing 
procedures or drugs, used to lessen fever are said to be 
antipyretic. Fever is now recognized merely as a 
symptom and in infectious diseases as a protective 
condition in which antibodies are formed to counteract 
toxins. Unless, therefore, the temperature is very 
high no attempts are made to lower it except for the 
purpose of making the patient more comfortable. 

Antipyretic Measures. — The object of antipyretic 
nursing procedures, such as fan baths and baths of 
tepid water or alcohol with much friction, is to quicken 
the circulation, bring more blood to the surface of the 
body, and thus increase heat loss. The administration 
of diaphoretics, such as hot drinks, Dover's powder, 
ammonium acetate, and spirit of nitrous ether have the 
same purpose. Pilocarpine, notwithstanding its power 
to cause excessive sweating, tends to raise the tem- 
perature. 

Antipyretic Drugs. — The drugs which have some use 
as antipyretics are the coal-tar analgesics, quinine, and 
aconite. The coal-tar analgesics act by depressing the 
heat centre. The heat centre is now considered rather 
a coordinated mechanism and the exact method by 
which this mechanism controls body temperature is 
not known, but it is probable that when it is depressed 






ANTIPYRETIC DRUGS 215 

heat production is decreased. The difficulty, however, in 
using drugs to depress this mechanism is that they also 
affect the vital centres and cause a general depression. 
Phenacetine, antipyrine, and acetanilid are especially 
depressing to the heart if given continuously in long 
fevers, but they are used to some extent. They relieve 
the nervousness which accompanies a high fever and 
are resorted to in cases in which baths cannot be given. 
Quinine is commonly employed as an antipyretic in 
the early stages of coryza. From 2 to 4 grains (0.1-0.25 
Gm.) every four hours will frequently break up a cold. 
Aconite is safe only in short, acute fevers and is being 
used less and less even in such cases, because of its 
toxic action on the heart (see page 157). 



CHAPTER XVIII. 

SPECIFICS. 

A specific is a medicine which by a highly selective 
action destroys some one organism in the body without 
harming the host. The serums will be considered in 
Chapter XXVIII. In this chapter will be described 
quinine, the specific against malaria; mercury and 
arsenic used against syphilis; emetine against amebic 
dysentery and the salicylates as antirheumatic remedies. 
It is not definitely known that rheumatism is caused 
by a germ, but the salicylates are very specific in their 
action in this disease. 

Quinine. 

History. — Quinine is an alkaloid derived from 
cinchona bark. Cinchonas are large, beautiful forest 
trees native to Bolivia and Peru but almost none of 
the bark now comes from wild trees. The cultivation 
of the cinchonas for medicinal purposes is at the present 
time carried on extensively in Java and India. The 
properties of this bark were said to have been learned 
from the natives by Spaniards who conquered Peru 
in the 17th century. The origin of its name is given 
in the story that the wife of a Spanish viceroy, Countess 
of Chinchon, was the first European to be cured of 



QUININE 217 

malaria by this new remedy and on recovery she 
gave away large quantities of the bark. For some 
strange reason there was much opposition to its use 
in England and it was not accepted in the medical 
profession until quack doctors had conclusively proved 
its value. Its alkaloid, quinine, is now being used 
exclusively. 

Action. — Its action was not understood until the 
life-history of the malarial organism was learned. These 
organisms develop in the stomachs of a certain species 
of mosquito, and when this insect bites a person the 
organisms pass into the blood stream along with the 
mosquito's saliva. In the blood of the host one form 
of the organism, the asexual, sporulates, that is, breaks 
up into spores, very resistant little bodies which con- 
tinue the life-cycle of the organism. During sporulation 
toxins are given out which cause the characteristic 
chills of malaria. It is at this stage that the organisms 
are most susceptible to quinine and if the drug is 
given 1 to 3 hours before an expected chill so that the 
blood is saturated with it at the time of sporulation 
the chill may be prevented. 

Administration.— Quinine bisulphate and hydro- 
chloride are the salts to be preferred as they are the 
most soluble. Hypodermic injections of the hydro- 
chloride of quinine and urea are also used. The usual 
dose of any quinine salt is 4 grains (0.25 Gm.), but in 
malaria 10 grain (0.6 Gm.) doses may be given. In 
malarial districts huge doses are taken daily as a pro- 
phylactic with no apparent ill effects. Warburg's 
Tincture and Antiperiodic pills are National Formu- 



218 SPECIFICS 

lary preparations used in malaria which are typical 
"shotgun prescriptions." They contain twenty dif- 
ferent ingredients. For administration to children the 
bitter taste of the medicine is disguised by making 
the insoluble tannate of quinine into chocolate-coated 
tablets called "quinine chocolates," or by giving it in 
the fluidextract of licorice or a syrup of verba santa, a 
drug which makes the taste organs unable to appreciate 
the bitter taste. 

Other Uses. — Minor uses of quinine are (1) as a gastric 
tonic, often in the form of cinchona preparations; (2) 
as a scalp stimulant in eau de quinine and other hair 
tonics; (3) as a uterine stimulant in labor; (4) as an 
antipyretic and analgesic in neuralgia and colds; (5) 
and in certain skin diseases. 

Cinchonism. — Large doses of quinine produce a con- 
dition called cinchonism, which is characterized by 
ringing of the ears, a sense of fulness in the head, and 
dizziness. The bromides relieve these symptoms. 

Other Alkaloids of Cinchona. — Cinchona contains 
besides quinine the alkaloids quinidine, cinchonine, 
and cinchonidine, all of which have the same action as 
quinine in malaria, but they are no better, are more 
expensive, and some are depressant. 

Antisyphilitics. 

Mercury. — Action. — In spite of new and much- 
lauded remedies, mercury still remains the one reliable 
specific in syphilis. Its action, so far as is now known, 
is to destroy the germs. It is thought that it may also 



ANTISYPHILITICS 219 

hasten the absorption of the products of inflammatory 
processes caused by the organisms. 

Administration. — The most common methods of 
administering mercury as an antisyphilitic are by 
mouth, by inunction, and by hypodermic injection. 
By whichever method given, the procedure is to give 
as much as can be borne (called mercurializing the 
patient) and to continue the treatment at intervals 
over a period of two years. 

By Mouth. — For administration by mouth, the salts 
most commonly employed are the protoiodide (Hgl, 
yellow iodide) and the biniodide (Hgl 2 , red iodide). 
Mercuric bichloride (HgCl 2 ) and potassium iodide 
KI) given together form the biniodide in the body. 
For a course of mercury in children the Gray Powder 
(mercury with chalk) is frequently used. The proto- 
iodide is usually given in a pill starting with i grain 
(15 mg.) daily. The dose of the biniodide is about 
to grain (3 mg.) daily. 

By Inunction. — For inunctions the Dilute Ointment 
of Mercury (blue ointment) is the preparation most 
used. The parts best adapted for absorption of the 
drug by this method are the axilse, groins, chest, back 
and abdomen, a different part being chosen on suc- 
cessive days. An infant can be easily mercurialized 
by putting the ointment under the flannel binder. 
Before the treatments are begun a thorough general 
bath should be taken and before each treatment the 
part to which the ointment is to be applied must be 
thoroughly cleansed with hot soap and water. A 
general bath is then allowed only once a week. 



220 SPECIFICS 

By Injection. — When mercury is administered by 
injection, it is given intramuscularly into the buttock. 
By this method a depot is established from which there 
is slow absorption. The salicylate or benzoate of 
mercury are the salts usually given by this method, 
and they are given in suspensions in liquid paraffin. 
The injections are repeated every two or three days. 
They almost always leave a local bruise and may cause 
headaches. This method is by far the cleanest and the 
most exact, and some physicians consider it the only 
way by which sufficient mercury can be introduced 
into the system. 

Untoward Actions. — The sign that a patient has had 
all the mercury he can bear is soreness of the gums. 
Some very susceptible people have skin eruptions, 
salivation, and deranged digestion from therapeutic 
doses. As a prophylactic in mercurial treatment, the 
mouth should be washed out twice daily with some 
astringent solution, such as a solution of potassium 
chlorate, tannin, or tincture of myrrh, and except 
when inunctions are being given the skin must be 
kept thoroughly clean by daily baths. 

Toxicology. — The first symptoms of acute mercury 
poisoning are corrosion of the mouth, esophagus and 
stomach, vomiting, and pain in the abdomen. The 
first-aid treatment is white of egg or milk followed 
by lavage. Demulcents and symptomatic treatment 
should then be given. Death is most frequently due 
to injury of the kidney through which the metal is 
excreted. 



ANTISYPHILITICS 221 

Salvarsan. — Origin and Action. — Investigators have 
long believed that arsenic would be a specific against 
syphilis if some compound could be found which could 
be given in sufficiently large doses to kill the germ 
without poisoning the patient. A number of organic 
preparations were made, such as atoxyl (sodium arsani- 
late), arsacetin (sodium acetyl arsanilate), arseno- 
phenylglycin, and sodium cacodylate, but their value 
is very doubtful. Dr. Ehrlich, a German investigator, 
thoroughly convinced that some such compound 
could be found, carried out a series of experiments 
which ended in the discovery of salvarsan, called 
"606" because it was the 606th compound made and 
tested in his series of experiments. The details of the 
composition of salvarsan are too complex to be ex- 
plained here but the one vital characteristic of the 
compound is that each arsenic atom has one unattached 
bond which, according to Ehrlich's theory, is like an 
empty hand reaching out and destroying the germs. Its 
graphic formula may be represented simply as follows : 

group of group of 

elements elements 

I I 

germ — As As — germ 

Neosalvarsan is a still more complex compound made 
in an attempt to avoid some of the disagreeable and 
dangerous side actions of salvarsan. They are both 
yellow powders kept in sealed tubes to prevent decom- 
position, and are unsafe for use after longer exposure 
to the air than is necessary to prepare them for ad- 
ministration. 



222 SPECIFICS 

Administration. — These drugs are administered intra- 
venously in sterile solutions. Salvarsan is given in 
saline, and, as it is strongly acid, is neutralized by the 
addition of small amounts of sodium hydroxide. Neo- 
salvarsan is neutral in reaction and is given in solution 
in water. The dose has to be carefully regulated to 
suit the individual case, the average being 10 grains 
(0.6 Gm.). When these remedies are given in the early 
stages of syphilitic infections sometimes a single dose 
will kill all the germs. This is not always the case, 
however, and often they are given in repeated weekly 
doses and in conjunction with mercury. The great 
advantage of their use is prompt removal of acute 
symptoms such as rashes and sores, thus lessening 
the chance of contagion. The disadvantage is that a 
patient, judging by external evidence, thinks he is 
cured and, regardless of microscopical evidence, 
contaminates others by marriage or conception of 
children. It is now an accepted fact that in most 
cases the two-year course of mercury must be taken, 
and, in the later stages of the disease, only mercury is of 
any value. 

Up to January, 1914, 214 deaths had been reported 
from the use of salvarsan and neosalvarsan. Frequent 
after-effects are headaches, nausea, and languor. 

Other Uses. — These drugs are specifics also in two 
tropical diseases which are caused by microorganisms, 
relapsing fever and frambesia (yaws). They are being 
tried in malaria and in the disorders usually treated by 
arsenic trioxide. 






SALICYLATES 



223 



Salicylates. 

Action. — As the cause of rheumatism is not known, 
the method of action of the salicylates cannot be 
explained. Their activity is due to the liberation of 
salicylic acid. It is very probable that the acid is 
excreted into the synovial fluids in the joints and thus 



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Fig. 20. — Clinical charts of cases of acute rheumatic fever treated 
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Case 2, 20 grains every two hours. (Stockman.) 



relieves articular rheumatism. The salicylates may 
also favor the excretion of uric acid. They markedly 
dilate the cutaneous bloodvessels, causing an increase 
in sweating and consequent lowering of temperature. 
A course of salicylates in acute rheumatism may make 
a patient exceedingly uncomfortable, because the 
large doses given in such cases often cause salicylism, 



224 SPECIFICS ' 

a condition of excessive sweating, ringing in the ears, 
deafness, extreme fulness in the head, and gastric 
irritation with nausea and vomiting. 

Minor Uses. — The salicylates are used as analgesics 
in neuralgia and headaches, and as antiseptics in eye 
diseases, but they have no such decided action in these 
cases as in rheumatism. 

Dosage. — Sodium salicylate is the salt most used in 
medicine. The dose is 15 grains (1 Gm.) and in acute 
cases this is repeated every hour until salicylism is 
produced. It must be given in dilute solution or with 
a copious drink of water if in capsule or cachet. 

Substitutes. — Substitutes for sodium salicylate are 
aspirin (page 131), novaspirin, salicin (a glycoside from 
willow trees), and methyl salicylate. Methyl salicylate 
(see page 139) is made synthetically from phenol, and 
because of traces of phenol left in it, the synthetic 
drug acquired a bad reputation. When properly 
made it is exactly as good as the natural product. 
The dose is 15 minims (1 Cc.) taken well diluted and 
when the stomach is not empty. Mesotan is a synthetic 
compound of this drug used for local applications. 

Atophan. 

Atophan is a new synthetic remedy for gout and 
rheumatism which is still in the experimental stage. 
It produces a prompt excretion of uric acid without 
affecting the amount of urine. To prevent the forma- 
tion of uric acid calculi in the bladder sodium bicar- 
bonate is frequently given with it. The dose is about 



EMETINE 225 

15 grains (1 Gm.) given with large quantities of water. 
Much larger doses may be given in acute cases. 



Emetine. 

Recent experiments have proved emetine, one of the 
active principles of ipecac, a specific in amebic dysen- 
tery. This disease, an infection of the intestines and 
liver by the amoeba dysenterise, is common in the 
Philippines and other tropical countries but rarely 
seen in this country. The hydrochloride is given sub- 
cutaneously in doses of J— 1 grain (0.03-0.06 Gm.). It 
is without value in other forms of dysentery. 



15 



CHAPTER XIX. 

REPRODUCTIVE SYSTEM. 

Drugs which affect the reproductive system may 
be divided into two groups: those which act upon 
the uterus in menstrual disorders or in labor, and those 
which stimulate or depress the sexual function. 

DRUGS WHICH AFFECT SEXUAL FUNCTION. 

Very little is known about drugs of this group. Those 
which stimulate the sexual function, as in cases of 
impotency, are called aphrodisiacs ; those which depress 
it are called anaphrodisiacs and are indicated in cases 
of excessive irritability of the sexual organs. 

Aphrodisiacs. — In general the treatment in impotency 
is to remove the cause and by hygienic living and 
general tonics, such as strychnine, iron and arsenic, 
to improve the general condition of the system. The 
drugs which are tried in such cases are irritants. 
Cantharides (Spanish flies) is frequently used but is 
dangerous on account of its irritant action on the 
kidneys. Ginseng, a drug which has a reputation 
in China as a specific in impotency, if used at all in 
this country, is given as a stomachic. 

Anaphrodisiacs. — In the case of excessive irritability 
the procedure is to remove the cause, decrease the 



DRUGS WHICH ACT ON THE UTERUS 227 

blood supply in the sexual organs by cold applications, 
and to depress the nerves by such drugs as atropine 
and hyoscyamus. 

DRUGS WHICH ACT ON THE UTERUS. 

Emmenagogues. 

Drugs which increase the menstrual flow are known 
as emmenagogues. They are indicated in cases of 
dysmenorrhea and absence of menstruation from 
various causes. Simple procedures which are effectual 
are hot foot or sitz baths, counter-irritants, such as 
a hot-water bottle or turpentine stupes over the uterus, 
and hot vaginal douches. General tonics are useful 
in improving the circulation. Strong purgatives will 
increase the blood supply of the uterus. 

Pennyroyal, tansy, savin, and rue are common 
herbs which were used in household medicine as 
emmenagogues and not infrequently to produce 
abortion. Each of them contains a highly irritating 
volatile oil which in large enough doses to cause 
abortion produces dangerous if not fatal results. For 
this reason many States have laws restricting the sale 
of the drugs or their oils. 

Uterine Sedatives. 

There are numberless preparations on the market 
which are purported to relieve menstrual pains. Most 
of these contain viburnum, a popular name for which is 



228 REPRODUCTIVE SYSTEM 

cramp bark. Other ingredients are cohosh, hydrastis, 
Pulsatilla, Jamaica dogwood, and wild yam (dioscorea) . 
The value of viburnum and these other herbs in such 
disorders has no support in clinical experience. Their 
wide use seems based on the fact that aborigines used 
them for such troubles, or on their successful exploita- 
tion by shrewd advertisers. Some of the preparations 
put out by the large drug firms are Elixir of Viburnum 
Compound, Elixir of Hydrastis and Cramp Bark 
Compound, Fluid Extract of Cramp Bark, Mother's 
Cordial, and Uterine Sedative Elixir. 

On the theory that the ovaries excrete some internal 
secretion which is necessary to the function of men- 
struation, experiments have been made with extract 
of ovaries and of the corpus luteum, a glandular body in 
the ovary which has a definite relation to ovulation. 
The best results have been obtained from these in 
relieving the nervous symptoms of menopause, either 
natural or postoperative. 

Ecbolics. 

Drugs which are given to check the menstrual flow 
or to increase the contraction of the uterus for the 
purpose of checking postpartum hemorrhage are 
called ecbolics. Extracts of the mammary gland have 
been tried with some success for this purpose in young 
girls and at the menopause. Hydrastis and hydrastinine 
are of value in menstrual hemorrhages. In the hemor- 
rhage following labor, epinephrine and pituitary extract 
are used to some extent but the drug of greatest value 



PLATE III 



Clavieeps Purpurea — Ergot of Rye. 
(Courtesy of Parke, Davis & Co.) 



DRUGS WHICH ACT ON THE UTERUS 229 

is ergot in the form of a fluidextract. The action of 
ergot depends on its several active principles which 
cause contraction of the uterine muscles, thus mechan- 
ically closing the ends of the bleeding arterioles. The 
dose of the fluidextract is 30 minims (2 Cc). It should 
not be given until just after delivery. No one of the 
active principles of ergot fully represents the action 
of the crude drug (see page 160). 



CHAPTER XX. 

DRUGS WHICH ACT ON SKIN AND MUCOUS 
MEMBRANES. 

Counter-irritants. — Counter-irritants are therapeutic 
agents applied to the skin for the purpose of relieving 
some deep-seated affection. When used only to the 
degree of producing redness, they are termed rube- 
facients; if they produce a blister they are called 
epispastics; if the irritation continues to the point of 
destroying the superficial tissues, they are termed 
caustics. 

Counter-irritation relieves the affection of the 
organ over which it is applied by reflex nerve relation 
between the skin and the organ, and by producing 
a change in the blood supply of the organ. The 
mental effect of the substitution of a new and super- 
ficial pain also assists in the result. The agents for 
counter-irritation are heat, friction, cupping, and drugs. 

Physical Measures. — Heat may be applied dry by 
means of a hot-water bag, electric pad, a thermocautery, 
hot flannels, or heated bags of inert substances such 
as bran, flaxseed meal, flour, or bread. The object 
in all these measures is to maintain a high degree 
of heat over a considerable period of time. 

Heat is applied wet in the form of stupes or a clay 
poultice. Stupes may be wrung out of hot water 



COUNTER-IRRITANTS 231 

alone, but more often oil of turpentine is added. The 
turpentine is mixed with about 4 parts of some bland 
oil (with 6 to 10 parts for children) and smeared 
over the surface which is to be covered by the wet 
cloths. The application is renewed between every 
two or three stupes according to the degree of red- 
ness produced. Wet stupes have a more penetrating 
action than dry heat, and addition of the volatile oil 
of turpentine still further increases the power of 
penetration. 

The official clay poultice (trade name, antiphlo- 
gistine) is a mixture of kaolin (clay), glycerin, and 
several aromatic and mildly antiseptic substances, oil 
of peppermint, thymol, and boric acid. It is of value 
as a means of retaining heat and it reduces swelling 
by abstracting water from the tissues. 

Friction is seldom used alone but should accompany 
the application of all liniments. Cupping is a purely 
mechanical method of reddening the skin by stretching 
it through suction, and temporarily increasing the 
blood supply in the area covered by the cup. In 
extreme conditions, such as pneumonia, edema of the 
lungs, and suppression of urine, recourse is sometimes 
had to this form of counter-irritation. 

Drugs.— The drugs employed as counter-irritants 
are ammonia, chloroform, turpentine, camphor, menthol, 
and capsicum in liniments, and mustard, capsicum and 
cantharides in poultices or plasters. Their value 
depends on the volatile and irritating properties of 
the drugs. Because of their penetrating power, the 
action of these drugs does not stop on removal from 



232 DRUGS WHICH ACT ON THE SKIN 

the surface. Therefore, when a blister is not desired, 
any application of the more irritating ones, the last 
three, must be removed before its full effect is 
obtained. 

Rubefacient. — Mustard is a counter-irritant because 
of the volatile oil of mustard which is formed when 
mustard is mixed with tepid water. It is used as a 
rubefacient but will form a blister if not sufficiently 
diluted or if in contact with the skin too long a time. 
Capsicum (cayenne pepper) has a similar action. 
Mustard is prepared for use as a counter-irritant 
in the form of a leaf, paste, or poultice. The leaf is 
purchased ready for use and has merely to be dipped 
in tepid water before application. A mustard paste 
is made by mixing with tepid water, mustard and 
flour in the proportion of one part mustard to about 
four parts of flour (1 to 10 for children). To prevent 
blistering the white of an egg may be added to the 
paste or the surface of the skin covered with oil or 
vaseline. The skin must be watched and the paste 
removed when a good degree of redness is obtained. 
It requires from five to fifteen minutes. A mustard 
poultice is made by mixing with tepid water mustard 
and flaxseed or linseed meal in the proportion of one 
part mustard to six or eight of meal (1 to 10 or 12 
for children). 

Epispastics. — Blistering is being used less and less 
as a therapeutic agent because of the pain of the treat- 
ment and the fact that it prevents for a long time 
further applications over the same area. Cantharides 
(Spanish flies) is the most common epispastic and a 



DISINFECTANTS 233 

fly-blister is produced by application of the cerate of 
cantharides spread on a piece of cloth. The blister 
appears in from five to ten hours and must be very 
carefully dressed as it is extremely susceptible to 
infection. Fly-blisters are occasionally used at the 
base of the brain to prevent effusion and over joints 
with effusions. 

Caustics — Caustics are employed to destroy abnor- 
mal growths such as warts, cankers, and granulations 
on wounds or the eyelids. It is very important in 
applying caustics to touch only the affected part. 
Their use at best is very painful and limited to small 
superficial areas. Silver nitrate in the form of a stick 
or in strong solutions is a familiar caustic. Organic 
compounds of silver and weak solutions of silver nitrate 
are valuable as antiseptics and astringents. (See 
Disinfectants, page 237.) Another caustic is chromium 
trioxide, Cr0 3 , sometimes called chromic acid. It is a 
powerful oxidizing agent and is used in medicine in 
the form of a stick or in solution. Pyrogallol is a 
highly irritant caustic (see page 128) used in fungous 
skin diseases, often in combination with zinc oxide. 
Copper sulphate in the form of a crystal, pencil, or in 
solution (0.1 per cent.) has special use as a caustic 
in trachoma. After its application the eye should be 
washed with warm water. For acids as caustics, see 
page 71. 

Disinfectants. 

Skin disinfectants are used in parasitic skin diseases, 
in septic sores, in fresh wounds to render them aseptic, 



234 DRUGS WHICH ACT ON THE SKIN 

and to sterilize an area for minor operations. For 
application to the skin the most important disinfec- 
tants are mercury, sulphur, tar, iodine, sodium hypo- 
chlorite, and certain coal-tar antiseptics. Those used 
on mucous membranes are iodine, hydrogen peroxide, 
the salts of silver, boric acid, and numerous mixtures. 



Disinfectants Used on the Skin. 

Mercury. — Mercury is applied in the form of oint- 
ments or lotions. Mercurial ointment, dilute mer- 
curial ointment (blue ointment), and ointment of 
ammoniated mercury (white precipitate ointment), 
are used for ordinary skin diseases; the ointment of 
mercuric nitrate for ringworm and venereal sores; 
and the ointment of yellow mercuric oxide for eye 
treatments. Black wash (solution of calomel in lime- 
water) and yellow wash (a solution of bichloride of 
mercury in lime-water), are used for treatment of 
venereal sores. 

Sulphur. — Sulphur disinfects by forming with the 
secretions of the skin sulphides which render the skin 
soft and aseptic. As the reaction is slow, the action 
of the drug is gradual and prolonged. Sulphur is 
known as washed sulphur, precipitated sulphur, or sub- 
limed sulphur, the difference between the three forms 
being the method by which they are purified. It is 
used in pure form or in an ointment for scabies and 
other skin diseases. Ichthyol is a sulphur compound 
of unpleasant odor obtained from the fossils of fishes. 



IODINE 235 

It has been prepared synthetically in an odorless form 
called thiol. The action of these compounds is not 
understood. They are used in solution or ointment 
to reduce inflammation in sunburn, infections, ery- 
sipelas, glandular and joint diseases. 

Tar. — Next to mercury and sulphur as skin disin- 
fectants is tar (pix liquida), an oleoresin obtained by 
distillation of pine wood. It has been said that the 
skill of a physician in treating skin diseases depends 
upon his skill in using tar. Besides being disin- 
fectant, it is a stimulant to the cells and a prolonged 
use without interruption causes a high degree of 
inflammation. It should be used with care on the 
axilla and face, and it should not be applied over 
any large area. The tar should be removed when the 
inflammatory state begins and applied again after it 
has subsided. A nurse should report the degree of 
inflammation. The oil and ointment of tar are used. 
The oil of cade, a tar from juniper having less un- 
pleasant odor, is often used as a substitute. 

Iodine. — Iodine, in the form of the tincture, has 
recently come into extensive use for the disinfection 
of fresh wounds and for sterilization of the skin before 
minor operations as well as for treatment of skin 
diseases. Because of its volatility it penetrates 
below the surface and as it enters into combination 
with the cell constituents it has a lasting effect. If 
the application of the tincture of iodine causes too 
severe burning, it can be washed off with alcohol. 
Iodine ointment is the form commonly used in diseases 
of the skin. 



236 DRUGS WHICH ACT ON THE SKIN 

Iodoform is a yellow powder, a compound of iodine 
having a very disagreeable odor, which is disinfectant 
to abraded surfaces only. There have been cases of 
systemic poisoning caused by the application of iodo- 
form gauze over large areas. Under such conditions 
vomiting or cerebral excitement or depression should 
be promptly reported. Numerous compounds have 
been made in an attempt to find an odorless substitute 
for iodoform. 

Aristol (thymol iodide), iodol, and europhen are 
iodine compounds used as antiseptic dusting powders. 
They are related to phenol and resemble it in action 
more than they resemble iodine. (See other com- 
pounds of iodine in N. N. R.). 

Coal-tar Antiseptics. — Phenol is one of the most 
familiar of this group. It has great power of pene- 
tration into the tissues and in this respect is superior 
to certain other antiseptics, such as bichloride of 
mercury, for its action on bacteria, but it is so toxic 
to the cells that its use is limited. A continued appli- 
cation of even very weak phenol ointment on an open 
wound or of compresses wet in weak phenol solutions 
not infrequently causes gangrene. Serious results have 
occurred from the latter method of treating a mild 
infection on the advice of a nurse. Phenol slightly 
paralyzes sensory nerve endings and for this action 
is used in certain skin diseases as an antipruritic (a 
drug which allays itching). (See Fig. 11, page 138.) 
The absorption of phenol may be detected by a dark, 
smoky urine, a slight cerebral excitement, and at 
times kidney irritation. Phenol is a powerful central 



IODINE 237 

depressant and in large doses causes almost instant 
collapse. Resorcin, another coal-tar antiseptic, has 
caused a number of cases of poisoning. It has a 
special use as an antiseptic of the scalp and is also 
used in lotions and ointment for the skin. Cresol 
(trade name, trikresol), picric acid, and pyrogallol 
are other useful coal-tar antiseptics (see Fig. 9, page 
128). 

Sodium hypochlorite (NaOCl) is a skin disinfectant 
due to the liberation of hypochlorous acid, a powerful 
oxidizing agent. This compound in solution is the 
official Solution of Chlorinated Soda, known as Labar- 
raque's solution. It is formed when chlorinated lime 
and washing soda are rubbed together on the wet 
skin. Solutions of hypochlorous acid (0.5 per cent, 
or less) have recently been employed as wound dis- 
infectants with some success. 

Various salts of zinc are much employed in skin 
diseases. They are all astringents as well as anti- 
septics, and relieve inflammation. The acetate and 
chloride are used in solution, the oxide and stearate 
in pure form or in ointment. Very weak solutions of 
zinc sulphate are used as astringents in the eye. 

Disinfectants Used on Mrcous Membranes. 

Iodine. — Iodine is used for painting the throat in 
solutions of the tincture, diluted according to the 
degree of action desired. Hydrogen peroxide or dioxide 
(H 2 2 ) is a compound which by readily liberating 
oxygen disinfects surfaces with which it comes in 



238 DRUGS WHICH ACT ON THE SKIN 

contact. It is much used in cleaning suppurating 
wounds and as a gargle. It is slightly irritant and 
should not be used full strength. Weak solutions of 
silver nitrate and organic silver compounds are in 
general use for the same purpose. The most common 
organic preparations are argyrol and protargol, com- 
pounds of silver and albumin. Others are albargin, 
argonin, novargon, silver citrate and lactate. (See 
N. N. R.) 

Boric Acid. — Boric acid is a very mild non-irritating 
antiseptic having special use in irrigations of the 
delicate membranes of the eye, ear, and bladder. A 
2 per cent, solution is commonly used. 

For gargle and mouth washes there are numerous 
preparations in vogue, some of undoubted value, 
others well deserving of the name "psychic anti- 
septics" which has been given to them. The official 
Antiseptic Solution contains boric and benzoic acids, 
thymol, eucalyptol and three volatile aromatic oils 
and over one-quarter of the whole mixture is alcohol. 
This is typical of many of the proprietary mixtures, 
listerine, glycothymoline, and borolyptol, for example. 
It is probable that the alcohol is responsible for much 
of their power as disinfectants. 

Lysol (see page 128) is a disinfectant used almost 
exclusively for vaginal douches in solutions in the 
proportion of one teaspoonful to a quart of water. 
There have been a number of cases of poisoning by 
lysol and recovery took place only when there was 
prompt lavage. 



ASTRINGENTS 239 

Astringents. 

Action and Uses. — Astringent drugs cause at the 
point of application constriction of the bloodvessels, 
a lessened permeability of their walls, and absorption 
of fluids which have exuded into the tissues. Their 
power to produce these effects is probably due to the 
fact that they form with the proteins of the cells hard, 
insoluble compounds which pucker the tissues. They 
have this local action only and are used in medicine 
on mucous membranes to check diarrhea (page 198), 
to reduce inflammation in the eye, pharynx, stomach, 
uterus, urethra, and rectum, and to stop hemorrhage. 
A drug with checks hemorrhage by an astringent 
action is called a styptic in distinction from a hemo- 
static which constricts the bloodvessels by stimulating 
the muscles or the vasoconstrictor nerves. Astringent 
drugs are used on the skin to promote healing and as 
antipruritics. 

Drugs. — Alum is a common astringent much used in 
gargles, enemas, and eye washes. It is a salt of the 
metal aluminium (popularly called aluminum) and 
contains in each molecule twelve molecules of water, 
called the water of crystallization. Burnt alum is the 
salt from which the water of crystallization has been 
expelled and it is used as a styptic. Alum gargles 
(from 1 to 5 per cent.) are somewhat injurious to the 
teeth. The solution of aluminium acetate has recently 
come into use as an astringent. It does not keep 
well and should be well diluted for application on the 
skin. Other metallic salts which have an astringent 



240 DRUGS WHICH ACT ON THE SKIN 

action are zinc oxide as a powder or an ointment, 
tincture of ferric chloride, and a solution of lead sub- 
acetate. The last is the active ingredient in the lead 
and opium wash much used in inflammatory conditions 
such as ivy poisoning. Tannin in any form acts as an 
astringent on the skin as well as on the mucous mem- 
branes. 

Styptics. 

The common styptics are ferric chloride, burnt alum, 
the tannins, absolute alcohol, and, in an emergency, 
powdered or granulated sugar which is antiseptic 
and promotes healing. Epinephrine is the best local 
hemostatic. 

Vulneraries. 

Wounds. — Vulneraries are medicines applied to 
open wounds to promote healing. They disinfect the 
wound, stimulate the surrounding tissues, and form 
a protective covering. Their use is limited chiefly 
to treatment of suppurating wounds and old ulcers. 
The balsam of Peru, a common vulnerary, is a natural 
exudation from a tree of the West Indies. The natives 
apply it at once to fresh wounds. It is a thick brown 
liquid used in the pure state. The tinctures of myrrh 
and benzoin are also used for this purpose, the latter 
pure, the former diluted five to ten times with water. 

Burns. — Common first-aid treatment for burns is 
Carron oil, 1 a mixture of equal parts of lime-water and 



1 The name is derived from a town in Scotland where this remedy 
was first used for treatment of the many cases of burns among 
workmen in the foundries, 



BURNS 241 

linseed oil. This is not a sterile preparation and should 
not be used when extensive areas have been blistered. 
It is applied on cloths and left on only until the burning 
sensation subsides. Another remedy used for burns 
is picric acid, a phenol derivative. Gauze can be 
secured which has been saturated in a solution of 
picric acid and dried. This is moistened, applied 
directly to the burn, and left on for several days. This 
drug may be absorbed and cause general depression, 
therefore it should not be used over large areas or 
on children. Simple first-aid remedies for burns are 
wet compresses of sodium bicarbonate or of salt solution. 
For later treatment sterile vaseline and boric acid 
ointment are used. 



16 



PART V. 

MISCELLANEOUS TOPICS. 



CHAPTER XXI. 
SUGGESTED TOPICS FOR REVIEW. 

1. Acids and alkalies. 

(a) Action in alimentary canal. 

(b) Local uses. 

(c) Effect on urine. 

(d) Precautions in their administration. 

2. Salts. 

(a) Which metallic salts are poisonous, and why? 
(6) Enumerate important remedies the effects of which are 
due to salt action. 

3. Name the important active principle of the fol- 
lowing drugs and state in which case it represents the 
action of the crude drug: 



Nux vomica. 


Ergot. 


Hyoscyamus. 


Digitalis. 


Opium. 


Physostigma. 


Coca. 


Adrenal gland. 


Belladonna. 


Cinchona. 


Ipecac. 


Hamamelis. 



4. Give four therapeutic uses of volatile oils. 

5. What is the therapeutic action of resins? To 
what class of medicines do resinous drugs chiefly 
belong? Cautions as to their use. 



244 



SUGGESTED TOPICS FOR REVIEW 



6. To what is the activity of the following drugs due: 



Iodoform. - 


Uro tropin. 


Lecithin. 


Amyl nitrite. 


Salol. 


Salvarsan. 


Ammonium carbonate. 


Aspirin. 


Argyrol. 


Ammonium chloride. 


Ichthyol. 





7. Give the first-aid chemical antidote for the 
following : 

Sulphuric acid. Digitalis. 

Arsenic. Bichloride of mercury. 

Ammonia water. Copper sulphate. 

Oxalic acid. Phenol (internally and externally). 

Morphine. Silver nitrate. 



8. Name the active ingredients of the following: 



Dover's powder. 
Paregoric. 
Comp. acetanilid 

powder. 
Hoffmann's anodyne. 



Blaud's pills. 
Basham's mixture. 
Fowler's solution. 
Comp. licorice 

powder. 
Comp. mixture of 

licorice. 



Hive syrup. 
Blue ointment. 
Thiersch's solution. 
Seidlitz powder. 
Gray powder. 



9. Give the drugs for which the following are popular 
names : 



Spirit of glonoin. 


Blue mass. 


Aristol. 


"White precipitate. 


Diuretin. 


Adrenalin 


Laudanum. 


Theocin. 




Epsom salts. 


Uro tropin. 





10. Give characteristic symptoms of overdosing by 
the following: 



Acetanilid. 
Atropine. 
Aconite. 
Strychnine. 
Copper sulphate. 
Arsenic. 

Chloral hydrate. 
Tartar emetic. 



Quinine. 
Morphine. 
Sodium bromide. 
Potassium iodide. 
Mercury. 
Sodium salicylate. 
Digitalis. 



SUGGESTED TOPICS FOR REVIEW 245 

11. Name drugs which are antagonistic in action to 
the following: 

Pilocarpine. Alcohol (systemic action). 

Morphine. Epinephrine (on bloodvessels). 

Homatropine (in eye). 

12. What change would be expected in the rate and 
force of the pulse beat after an administration of the 
following? 

Strychnine. Veratrum. 

Ether (inhalation). Epinephrine (intravenously). 

Digitalis. Chloral hydrate. 

Aconite. Iron. 

Caffeine. Morphine. 

13. What special points should be observed in pre- 
paring and administering a dose of the following? 

Hydrochloric acid. Aromatic spirit of ammonia. 

Sodium salicylate. Saline cathartics. 

Charcoal. Paraldehyde. 

Potassium iodide. Sulphonal. 

Tincture of ferric chloride. Castor oil. 

Dover's powder. Croton oil. 

Hoffmann's anodyne. Nitroglycerin. 

14. By what method are the following drugs given 
(mouth, inhalation, injection, and so on)? 

Apomorphine. Morphine. 

Pituitary extract. Quinine and urea hydrochloride. 

Tincture of benzoin. Cocaine. 

Mercury. Homatropine. 

Ammonium chloride. Stramonium. 

15. Give the dose of the following: 

Strychnine as stimulant. Apomorphine (as emetic). 

Atrophine as stimulant. Chloral hydrate. 

Caffeine. Phenacetine. 

Morphine. Potassium iodide. 

Paregoric. Tincture of digitalis. 

Spirit of nitroglycerin. Fowler's solution. 



246 SUGGESTED TOPICS FOR REVIEW 

16. Name six commonly used drugs which tend to 
produce a drug habit. 

17. Give the popular names for the following drugs: 

Phenyl salicylate. Thymol iodide. 

Hexamethylenamine. Spiritus frumenti. 

Sodium and potassium Liquor potassii arsenitis. 

tartrate. Calcium hydroxide. 

Potassium bitartrate. Calcium carbonate. 
Magnesium sulphate. 



CHAPTER XXII. 
DRUGS OF MINOR IMPORTANCE. 



Adonis Vernalis. — Action similar to digitalis. The dose of the 
fluidextract is 1-2 minims (0.06-0.1 Cc). Its active principle is a 
glucoside adonidin, dose tV grain (0.006 Gm.). 

Agar-agar. — A substance obtained from sea weeds which will 
absorb water and form a jelly. Extensively used as a culture 
medium in bacteriology. Used in medicine to cure constipation, 
its action being to start peristalsis by increasing the bulk of the 
bowel content. Prepared in powder or in shreds either of which 
may be taken alone or mixed with food. The dose is lf-4 drams 
(5-15 Gm.). The action may not appear for several days, but when 
it starts daily administration will produce daily soft natural stools. 

Anise (incorrectly called Anise seed). — A drug whose activity is 
due to a volatile oil. The oil of anise is aromatic and has a mild 
carminative and expectorant action. It is contained in paregoric 
and various cough mixtures chiefly as flavor, and is useful as a 
carminative for young children. The dose is 3 minims (0.2 Cc). 

Apinol. — A compound derived from the distillation of pine wood. 
Used externally on wounds and sores as an anodyne and a vulnerary; 
internally for catarrh of the digestive tract; by inhalation as an 
expectorant. 

Apiol. — A derivative of the seeds of garden parsley. Used in 
doses of 2-5 grains (0.1-0.3 Gm.) as an emmenagogue, and 4-15 
grains (0.25-1 Gm.) as an antipyretic. 

Apocynum (dogbane). — A drug with digitalis action but it is 
not well absorbed. The dose of fluidextract is 2-10 minims (0.1- 
0.6 Cc). 

Arnica. — Used in the form of the tincture in liniments for bruises 
and sprains, and as an antiseptic and stimulant in wounds. 

Aspidosperma. — Resembles apomorphine in action; used occa- 
sionally as an expectorant. Fluidextract \-l dram (1-4 Cc). 

Betanaphtol. — A coal-tar derivative. Used externally in ointments 
as an antiseptic and as an anthelmintic in hookworm disease; inter- 
nal use dangerous because if absorbed to any extent nephritis 
results. The dose is 2-5 grains (0.1-0.3 Gm.). 

Boneset. — A common wild herb used in the form of a fluidextract 
or "boneset tea" as a diaphoretic home remedy to break up colds 
and fevers. 



248 DRUGS OF MINOR IMPORTANCE 

Bromipin. — A bromine derivative of sesame oil; a substitute for 
the bromides claimed to be more lasting in action and to be less 
likely to produce bromism. Prepared in 10 per cent, and 33^ per 
cent, solutions. The dose of 10 per cent, is 1 dram (4 Cc.) ; of 
33| per cent., 20 grains (1.3 Gm.). In epilepsy the dose may be two 
to eight times as large. 

Bromoform (CHBr3). — A compound similar in composition to 
chloroform (CHCh), bromine being substituted for chlorine. An 
antispasmodic limited in therapeutics to whooping-cough. A power- 
ful narcotic and should be handled with care. The adult dose is 
5 minims (0.3 Cc.) dissolved in alcohol or oil. It requires about 5 
drops to obtain 1 minim of bromoform. 

Cannabis. — A narcotic poison used by drug habitues in India 
under the name of "hashish;" has been tried as a hypnotic, but 
undesirable because of danger of habit formation. Official prepara- 
tions are tincture, dose 8 minims (0.5 Cc), and extract, dose j grain 
(0.01 Gm.). 

Catechu (gambir). — Because of tannin content is an astringent. 
Compound tincture 1-2 drams (4-8 Cc). 

Chloralformamidum (chloralamide).— Compound of chloral, 
claimed to be less depressant to the heart. The dose is 15-30 grains 
(1-2 Gm.) in powder, capsule, or elixir. 

Chloretone. — A compound of chloroform which has been tried 
as a preliminary to ether as an anesthetic. Used in powder or solu- 
tion as a local sedative on ulcers or decayed teeth, and as an anti- 
emetic in cases of persistent vomiting. 

Chrysarobin. — A yellow powder used as an antiseptic and stimulant 
in skin diseases, especially in chronic cases (page 206). More powerful 
than tar. Used in ointment or solution. It stains the skin, hair, nails, 
and clothing, but can be removed from the latter by dilute solution 
of sodium hydroxide (caustic soda) or Labarraque's solution. 

Colchicum. — In form of a tincture, a remedy for acute gout; 
of little value in rheumatism. Large doses cause nausea and 
purging. The dose is 30 minims (2 Cc). 

Convallaria (Lily of the Valley). — Resembles digitalis in action, 
but is much more poisonous. Fluidextract, 10 minims (0.6 Cc). 

Copper Sulphate. — In dose of j grain (0.01 Gm.) is used occa- 
sionally as an intestinal astringent in cases of chronic diarrhea. 

Creolin. — A proprietary mixture of cresol in soap solution, simi- 
lar to Compound Cresol Solution (U. S. P.). Used as antiseptic in 
ointments, in irrigations, and for wet dressings. Solutions must be 
made with warm water. 

Cusso. — Anthelmintic used for tapeworm. The dose is 1-4 drams 
(4-16 Gm.). 

Dionine. — A derivative of morphine used to some extent as a 
substitute for it in mild cases. Used locally in certain eye diseases 
to produce a vasodilatation. 

Duboisine. — An alkaloid similar to atropine in action. Used as 
sedative for the insane. Dose is tJit-iV grain (0.6-1.5 mg.). 

Euphthalmin. — A substitute for atropine used in eye examinations; 
action is prompt and not prolonged. 



OIL OF CLOVES 249 

Fennel. — A carminative, the action of which is due to its volatile 
oil. 

Frangula (Buckthorn). — A cathartic resembling cascara. 

Gelsemium (Yellow Jasmine). — A central depressant used some- 
times as an analgesic in facial neuralgia; also a mydriatic. Its 
active principle is an alkaloid, gelseminine. 

Ginger (Zingiber). — In the form of the tincture used as gastric 
tonic and carminative. Dose of tincture, 30 minims (2 Cc). 

Glauber's Salt (Sodium sulphate). — Dose 2 drams (8 Gm.) as 
a saline cathartic. 

Grindelia. — An expectorant. Fluidextract, 30 minims (2 Cc). 

Guaiacum. — A resin from guaiac wood thought to have some use 
as an alterative. Whatever good may result probably due to slight 
stimulation of the gastro-inte'stinal tract. Tincture, dose 1 dram 
(4 Cc); ammoniated tincture, 30 minims (2 Cc). 

Hops. — A mild nerve sedative; active principle is lupulin. 

Hormonal. — A liquid extract derived from the spleen of the rabbit 
at the height of the digestive processes ; claimed to possess the power 
of exciting peristalsis when given intravenously or intramuscularly. 
It is still in the experimental stage. 

Hydrastis. — Resembles strychnine as a general tonic and ergot 
as an emmenagogue, especially at menstruation. On mucous 
membranes it is used as an astringent to reduce chronic inflamma- 
tion as in catarrh and gonorrhea. One of its active principles is an 
alkaloid, hydrastine, and from it an artificial alkaloid, hydrastinine, 
is derived which is an emmenagogue. Dose of fluidextract, 30 
minims (2 Cc.) ; of tincture, 1 dram (4 Cc.) ; of hydrastine, j of a 
grain (10 mg.) ; of hydrastinine hydrochloride, f of a grain (30 mg.). 
For local treatment the fluidextract is used (1-8 parts of water) or 
the tincture (1-2 parts of water). Cotarnine, a derivative of narco- 
tine, popularly called Stypticin, and hydrastinine are practically 
identical in action. 

Hydriodic Acid. — A 10 per cent, solution in water sometimes 
given in doses of 1 dram (4 Cc.) for the same purposes as an iodide. 

Lobelia (Indian Tobacco). — Used as antispasmodic in asthma. 
Fluidextract, 2 minims (1.3 Cc). Overdoses causes nausea and 
collapse. 

Lugol's Solution. — Compound solution of iodine; an aqueous 
solution suitable for injections of iodine. 

Manna. — A saccharine exudation from a species of ash tree which 
acts as a weak laxative. It contains 90 per cent, of mannite, a 
peculiar sugar which by salt action increases the bulk of the bowel 
content. 

Matricaria (German chamomile). — Action as carminative due to 
its volatile oil. Also used with large quantities of hot water as a 
home remedy to break up colds and as an emmenagogue. 

Oil of Cloves. — An antiseptic volatile oil sometimes used as a 
carminative and frequently in dentistry as an anodyne. For inser- 
tion in a cavity it may be used on cotton in full strength. The dose 
is 3 minims (0.2 Cc.) on sugar or in finely cracked ice. 



250 DRUGS OF MINOR IMPORTANCE 

Oil of Theobroma (Cacao Butter). — A fixed oil used as a lubricant 
in massage, as a soothing application to sore nipples, and as a base 
for suppositories. 

Orthoform. — A benzoic acid derivative used externally pure, in 
powders and in ointments as an antiseptic and anodyne. 

Pelletierine Tannate. — A mixture of tannates of the alkaloids of 
pomegranate used as an anthelmintic. The maximum dose is 5 
grains (0.3 Gm.) ; large doses cause paralysis. 

Phytolacca (Poke Root and Berries). — The root and berries used 
popularly as cathartics and alteratives; active principles not known. 

Piperazine. — A synthetic drug of doubtful value as an anti- 
rheumatic. 

Pumpkin Seed (Pepo). — Used in an infusion as anthelmintic in 
cases of tapeworm. 

Saccharin. — Derivative of benzoic acid used as a substitute for 
sugar in diabetes. Has no food value; tends to derange digestion. 
The dose is 3 grains (0.2 Gm.). 

Salophen. — A derivative of salicylic acid used as an antirheumatic. 

Sanguinaria (Bloodroot). — An ingredient of cough mixtures used 
as an expectorant. 

Sarsaparilla. — A drug long valued as a spring tonic. Its only active 
ingredient is a saponin which may have some slight stimulating 
action on the stomach. Compound Syrup of Sarsaparilla is useful 
as a vehicle for castor oil and other drugs. 

Scoparius (Broom Top). — Has a diuretic action. The dose is 15 
grains (1 Gm.). 

Senega. — An expectorant. The dose is 15 grains (1 Gm.). 

Sparteine. — An alkaloid, the action of which on the heart resembles 
that of aconite. The dose is variously given from f-l§ grains 
(0.01-0.1 Gm.). 

Spigelia. — Anthelmintic for roundworm. 

Staphisagria. — Also called stavesacre, larkspur, and delphinium. 
Much used as parasiticide for head lice in the form of the tincture, 
pure or mixed with equal parts of ether. It is a systemic poison 
resembling aconite and toxic symptoms are similar. 

Tragacanth. — A gum resembling acacia; its mucilage used as base 
in many pharmaceutical preparations. 



CHAPTER XXIII. 
PRESCRIPTIONS. 

A prescription is a written order from a physician 
to a pharmacist to supply the patient with medicines 
prepared in certain forms. It includes also directions 
to be written on the label of the bottle in regard to 
the time and method of applying or taking the medicine. 
It is the duty of the physician to make his directions 
clear and accurate. The pharmacist checks up the 
prescription and consults the physician if there is any 
doubt as to its meaning or accuracy. He must know 
the best method by which prescribed preparations can 
be made and usually the choice of vehicle and coating 
for pills is left to him. The physician, and particularly 
the pharmacist, must ' know what drugs are incom- 
patible — that is, cannot be prescribed together because 
of some chemical reaction that would take place between 
them.* 

It has always been the custom for prescriptions to 
be written in Latin but at the present time there is a 
strong tendency to use English. The advantage of 
the use of Latin is that it is frequently desirable to 
conceal from the patient the nature of the medicine. 
In certain mental and nervous conditions a very mild 
remedy with a long unfamiliar Latin name frequently 



252 PRESCRIPTIONS 

does more good than a familiar one which is more 
drastic. Some patients fancy that they cannot take 
certain medicines but take them willingly under their 
Latin names. A doctor has to be very tactful in thus 
deceiving his patient and should discriminate carefully 
between a fancy and an idiosyncrasy. The disad- 
vantages of using Latin are that many physicians 
use it in bad form, sometimes dubbed "hog Latin," 
and that in most cases a patient has a perfect right 
to know what he is taking. 

Whatever system of weights and measures is used, 
it is understood that solids are measured by weights 
and liquids by liquid measure. When the metric 
system is used the tendency is to write only the 
figures, it being understood that whole numbers are 
grammes or cubic centimeters and that decimals are 
fractions of these. In haste a decimal point might 
easily be made to look like the figure 1, and to avoid 
any confusion a line is drawn where the points would 
be as is shown in the following prescription: 



For George Bennet 


August 20, 1914. 


1$ — Strychnine sulphate, 

Aloin, 

Extract of belladonna, 
M. and make into 10 pills. 
Sig. — Take one at bedtime. 






Dr. G. 


015 

2 

06 

K. Rose. 



The quantities are 0.015 Gm. of strychnine sulphate, 
0.2 Gm. of aloin, and 0.06 Gm. of the extract of bella- 
donna. The symbol 1^ at the beginning of the pre- 
scription stands for the Latin word "recipe," meaning 
u take thou." If Latin is used the names of the in- 
gredients are in the genitive case, which corresponds 



PRESCRIPTIONS 253 

to the possessive case in English. The prescription 
above would be as follows in Latin: 



George Bennet 


August 20, 1914 


1$ — Strychninse sulphatis, 

Aloini, 

Extracti belladonnse, 
Misce et fiant pilulae No. x. 
Sig. — Take one at bedtime. 






Dr. G. 


015 

2 

06 

K. Rose 



This reads: Take 0.015 Gm. of strychnine sulphate, 
0.2 Gm. of aloin, 0.06 Gm. of the extract of bella- 
donna, mix and make into ten pills. The form of 
most Latin words is so similar to the English that 
one who has never studied the language can usually 
tell without difficulty what is meant. There are a 
few abbreviations familiarity with which will enable 
a nurse to understand a prescription. As a rule, the 
first part of a word is used for its abbreviation, for 
example, "syr." for syrup, "tinct." for tincture. 



M. 


= 


misce, mix. 


Ft. 


= 


fiant, make. 


Pil. 


= 


pilula, pill. 


Cap. 


= 


capsula, capsule. 


Chart. 


= 


chartula, paper. 


Aq. 


= 


aqua, water. 


aa 


= 


ana, of each. 


q.s. 


= 


quantum sufficiat, as much as may be 
required. 


Sig. 


= 


signa, write on label. 


a. c. 


= 


ante cibum, before meals. 


p. c. 


= 


post cibum, after meals. 


Stat. 


= 


statim, at once. 



254 PRESCRIPTIONS 



q.h. 


= 


quaque hora, every hour. 


q. 2 h., 


3h. 


, 4 h. = every 2, 3, or 4 hours 


o. d. 


= 


omni die, daily. 


b. i. d. 


= 


bis in die, twice a day. 


t. i. d. 


= 


ter in die, three times a day. 


4i. d. 


= 


four times a day. 


p. r. n. 


= 


pro re nata, when required. 


s. o. s. 


= 


si opus sit, when required. 


c. 


= 


cum, with. 


s. 


= 


sine, without. 


ad 


= 


up to. 


et 


= 


and. 



P. P. on the top of a prescription means poor patient, 
and is a request to the pharmacist to make the lowest 
possible price. 

Ne rep. (ne repetatur) on a prescription indicates 
that it is not to be refilled. 

The following prescriptions illustrate the form used 
for different preparations. For convenience the date 
and names of patient and doctor are omitted. 

(1) 1$ — Tinct. gentianse comp., Siij 
Sig. — 3j a. c. 

(2) 1$ — Sodii bicarb., 3iss 

Tincturse gentianse comp., gss 

Tincturse quassise, 3ij 

Syrupi zingiberis, q. s. ad 3ij 

M. et Sig. — 3J Q- 2 h., for gastric pain. 

(3) ]$ — Bismuthis subnitratis, 4 00 

Zinci oxidi, 1 00 

Glycerini, 5 00 

Phenolis, 60 

Petrolati albi (white vaseline) , 90 00 

M. et ft. ungt. 

Sig. — For ivy poisoning. 



PRESCRIPTIONS 255" 



(4) T$ — Olei ricini, TTLxxx 

Phenylis salicylatis, gr. xxx 

M. et ft. in cap. No. xii. 
Sig. — One capsule q. 4 h. 

(5) 3— Tinct. digitalis, 30 Cc. 
Sig.— Take 1 Cc. o. d. 

(6) J$ — Cretse prseparatse, 

Sodii bicarbonatis, aa 15 Gm. 

M. et ft. in chart, No. xx. 
Sig. — One powder in glass of hot water t. i. d. 2 hr. p. c. 



(7) 1$ — Hydrargyri iodidi rubri, 

Extracti nucis vomica?, 1 

Ferri lactatis, 
Quininse bisulphatis, aa 4 

M. ft. pil. No. lx, coat. 

Sig. — One pill p. c. for gastric acidity. 



(8) Ifc — Extracti belladonnse, gr. iss 
M. in oleum theobromatis q. s. ad. suppos. No. vi. 
Sig. — Insert 1 suppos. b. i. d. 

ne rep. 

(9) 1$ — Vini erythroxyli, 5iv 
Sig. — Take 3ij stat. et q. 4 h. for vomiting. 

(10) 1$ — Antipyrinse, gr. xlviij 

Sodii bromidii, 3ij 

Codeinse, gr. v 

Syr. rubi idsei (raspberry), gij 

Aq. destil. (distilled), q. s. ad $iv 
M. et Sig.— 3"i q. 4 h. 

(11) 1$ — Ampulae amylis nitritis, lUiij, No. xii 
Sig. — Break in towel and inhale p. r. n. 

(12) 1$ — Sodii salicylatis, 3J 
Ft. cachetse No. xii. 

Sig. — 1 cachet q. h. 



CHAPTER XXIV. 
EXPERIMENTS. 



Apparatus required for one desk. (Two students can easily work 
together) . 

6 test-tubes. Square of gauze, 8 by 8. 

Mortar (4| in.) and pestle. Gas burner. 

Glass funnel (4§ in.). Gold beater's bag or parch- 

Ring stand with at least two rings. ment thimble. 

100 Cc. cylindrical glass measure. 8 oz. beaker. 

10 Cc. cylindrical glass measure. 16 oz. beaker. 

Evaporating dish. Test-tube rack. 

Glass stirring rod. Glass cover for large beaker. 

Filter paper (three pieces of 7 in.). Water-bath. 

If regular laboratory equipment is not easily available the last 
five articles can be dispensed with by using ordinary dishes and any 
kind of a double boiler arrangement for a water-bath. The cost 
of the chemicals and drugs required for a class of twelve will be 
about two dollars. 



I. True Solutions and Suspensions. 

(a) Fill two test-tubes about half-full of water. Put 
a few grains of chalk into one and the same amount 
of sodium bicarbonate into the other. Agitate both. 
Compare results at once and after standing. 

(6) Take about 10 Cc. of water in one test-tube, 
10 Cc. of alcohol in another. Drop a few drops of some 
oil into each. Agitate and compare results as above. 

II. Effect of Heat on Solubility. 

Put into two test-tubes 10 Cc. of water and 8 grains 
(0.5 Gm.) of boric acid. Heat one to boiling and agitate 



PHARMACEUTICAL PREPARATIONS 257 

both for several minutes. Note the difference in the 
amount of acid dissolved. When it is all dissolved the 
solution will be saturated at ordinary temperatures. 
To the hot solution add another 8 grains (0.5 Gm.) of 
boric acid and agitate until dissolved. Let it cool 
and note the precipitate at the bottom of the tube. 
However much may be dissolved in the water when 
hot after cooling it will hold only 8 grains (0.5 Gm.) 
of the acid. 

III. Pharmaceutical Preparations. 

The purpose of the exercises is to give a practical 
knowledge of the nature of the different preparations. 
No nurse should consider herself competent to make 
these or other preparations for actual use as medicines 
unless she has had special training under a licensed 
pharmacist. 

1. Water. — Make Cinnamon Water, U. S. P., using 
half the quantities. The purpose of the talc is to 
separate the oil, which is very slightly soluble in water, 
into finely divided particles, so that as much of it as 
possible comes in contact with the water and enters 
into solution. 

2. Solution. — Make Solution of Potassium Arsenite 
(Fowler's Solution) by the following recipe: 



Arsenic trioxide, 




1 Gm. 


Potassium bicarbonate, 




2 Gm. 


Comp. tr. of lavender, 




3 Cc. 


Water, 


q. s. 


100 Cc. 



Boil first two ingredients with 10 Cc. of water until 
solution has been formed. Add enough water to make 
17 



258 EXPERIMENTS 

97 Cc. Lastly add Comp. Tr. of Lavender and filter. 
The chemical reaction is seen in the following equation : 

As 2 3 + 4KHC0 3 -> 2K 2 HAs0 3 + 4C0 2 + H 2 
Arsenic Potassium Potassium 
trioxide. bicarb. arsenite. 

3. Mucilage. — Show Mucilage of Acacia as example. 
About four hours are required to dissolve the gum. 
The lime-water reacts with an acid in the gum, thus 
preventing fermentation and forming a product which 
makes a smooth consistency. 

4. Spirit. — Make Spirit of Cinnamon, L T . S. P., 
using ^0 of quantities. 

5. Elixir. — Show Elixir of Iron, Quinine, and Strych- 
nine Phosphates as example. 

6. Glycerite. — Make Glycerite of Tannic Acid, U. 
S. P., using 5 Gm. of tannic acid and 16 Cc. of glycerin. 

7. Oleates. — Show specimen of oleic acid and oleate 
of mercury. 

8. Collodion. — Flexible collodion is a common 
example. Burn some in an evaporating dish to show 
its inflammability. 

9. Infusion. — Make an infusion of buchu leaves, 
using 5 Gm. of leaves and 100 Cc. of water. Use 
gauze as strainer. 

10. Tincture, Fluidextract, and Extract. — These 
require special apparatus and a long time. The 
processes should be demonstrated by a pharmacist. 
Good illustrations of the three preparations are the 
tincture, fluidextract, and extract of digitalis. 

11. Oleoresins. — Show Oleoresin of Aspidium, U, S f 
P,j as example. 



PHARMACEUTICAL PREPARATIONS 259 

12. Emulsion. — This is difficult to make well and 
should be demonstrated by a pharmacist. 

13. Mixture.— Make Chalk Mixture, U. S. P., using 
half the quantities. 

14. Liniment. — Make Lime Liniment, L T . S. P., using 
smaller quantities. 

15. Triturate. — Follow general directions in U. S. P., 
using any drug desired. 

16. Pills. — These require special apparatus and skill 
and should be demonstrated by a pharmacist. Show 
specimens of bolus, granule, and troche. Demonstrate 
the difference between a tablet triturate and a com- 
pressed pill by crushing one of each. 

17. Ointment. — Make Boric Acid Ointment, U. S. P., 
using 7^q of the quantities. Making ointment on a 
slab should be demonstrated by a pharmacist. 

18. Suppositories. — Show examples of the rectal, 
vaginal, and urethral. 

19. Powder. — Make Powder of Ipecac and Opium, 
U. S. P., using yq the quantities. 

Make Granular Effervescing Sodium Phosphate* 
by the following recipe: 



Exsiccated sodium phosphate, 

Saccharated sodium bicarb., 4 

Saccharated tartaric acid, 2 

Saccharated citric acid, 2 



5 Gm. 
75 Gm. 
3 Gm. 
3 Gm. 



Mix the ingredients in a mortar; transfer to an 
evaporating dish and heat over a water-bath (not too 
hot), stirring constantly with a glass rod. When 
granules have formed, remove the mixture from the 
water-bath and stir until dry. Test for effervescence, 



260 EXPERIMENTS 

The correct method of folding a powder paper 
should be taught by a pharmacist. 

20. Plasters and Papers are usually made wholesale. 
Samples may be shown if their appearance is not 
familiar. 

IV. Acids and Alkalies. 

Make a solution of egg albumin by dissolving the 
white of one egg in 100 Cc. of water and straining. 
Put 2-3 Cc. of this in each of six test-tubes, and add the 
following substances all in full strength, drop by drop: 

1. H 2 S0 4 . 

2. HC1. 

3. HN0 3 . 

4. Phenol. 

5. Alcohol. 

V. Salt Action. 

Sugar in the form of molasses is used in this experi- 
ment because it gives very marked results. 

Test the gold beater's bag to be sure that it has no 
hole in it. Fill it about one-quarter full of molasses 
and tie it securely at the top. Mark in ink on the bag 
the highest point which the liquid inside reaches when 
the bag is suspended. Place the bag in water so 
that the molasses is below the water line. Let stand 
for two hours. Then note the presence of water in the 
bag and the sweet taste of the water in the glass. The 
same principle can be shown by weighing the contents 
of the bag before and after immersion in the water. 

If a parchment thimble is used, the procedure is the 
same except that it cannot be tied at the top. 



ACTIVE PRINCIPLES OF PLANTS 261 

VI. Salts. 

Make a solution of egg albumin as in preceding 
experiment. To small quantities add, drop by drop, 
solutions of following: 

1. HgCl 2 (1:1000). 

2. AgNOa (10 per cent.). 

3. Pb(C 2 H 3 2 )2 (sat. alcoholic solution). 

4. CuS0 4 (1 percent.). 

5. FeCl 2 (Tr.). 

VII. Antidotes to Poisons. 

The action of a few antidotes can be nicely shown 
in test-tubes. Add a little lime-water to a solution 
of oxalic acid, some strong tea to a solution of an 
alkaloidal salt, some albumin solution to bichloride of 
mercury in solution. 

VIII. Active Principles of Plants. 

1 . Glucosides (salicin as type in a 2 per cent, solution) . 

(a) Take about 6 Cc. of solution and test for sugar 
by Fehling's reagent. 

(b) Take 25 Cc. of solution, add 2§ Cc. of dilute 
H 2 S0 4 . Place this over a water-bath for ten minutes, 
then neutralize with sodium hydroxide and test this 
for sugar. 

2. Oils. — Pour one drop each of oil of cinnamon 
and of cottonseed oil on a piece of glazed paper. Com- 
pare appearance of spot. Heat paper gently. Note 
change and odor. 



262 EXPERIMENTS 

3. Saponins. — Put two or three pieces of quillaja 
bark in water in a test-tube and shake. 

4. Alkaloids (quinine as type). — Add 0.1 Gm. of 
alkaloid to 25 Cc. of water. Note solubility and 
reaction to litmus. 

Add about \ Cc. of dilute H 2 S0 4 to above. Shake 
and add more acid until the alkaloid disappears. 
What is formed and why did it disappear? 

Put some of above in three test-tubes and test with 
potassium permanganate, tea, and coffee. 

5. Resins. — Add 0.03 Gm. (gr. \) of a resin (podo- 
phyllum for example) to 5 Cc. of alcohol and an equal 
amount of 5 Cc. of water. Compare solubility. 

6. Tannins. — Make a strong solution of tannic acid 
and add some of it to a solution of albumin. What 
is formed? 

IX. Iron Compounds. 

Put in test-tubes small quantities of ferric citrate, 
ferratin, ovoferrin, hemoglobin, and the tincture of 
ferric chloride, all in solution. Drop into each a few 
drops of potassium ferrocyanide, a reagent which 
produces a blue color with free iron. Those in which 
this color appears are inorganic preparations of iron. 
Into the tubes where no color is obtained put a small 
quantity of hydrochloric acid. This breaks down the 
combination and frees the iron. If no color then appears- 
some still stronger reagent would have to be used to 
break down the compound. The substances which 
have to be broken down before the blue color appears 
are organic forms of iron. 



CHAPTER XXV. 

LEGISLATION CONCERNING POISONS 
AND HABIT-FORMING DRUGS. 1 

The earliest legislation in regard to the sale of 
poisons in this country was enacted in New York 
State in 1829. It was then required that a " Poison" 
label be put on "arsenic, corrosive sublimate, prussic 
acid, or any other substance or liquid usually denomi- 
nated poisonous." In 1848 New Hampshire passed a 
law requiring a record of the sale of the three poisons 
named in the New York law, and" four years later 
Ohio required by law both a record and the "Poison" 
label. 

As early as 1860 the evils of the opium and morphine 
habits were well recognized and the use of these drugs 
was on the increase, but in spite of the best efforts 
of medical men there was no legislation against their 
sale or use until the enactment of the Ohio Anti-opium 
Smoking Law in 1885. As cocaine was not discovered 
until 1884 its use as a habit-forming drug was not 
wide-spread until some years later, and the first laws 
prohibiting its sale without a prescription were passed 
by Illinois in 1897. Since that date, up to 1912, all 



1 For detailed information see Public Health Bulletin No. 56, "A 
Digest of Laws concerning Poisonous and Habit-forming Drugs." 
This may be secured from the Government Printing Office at 

Washington. 



264 LEGISLATION OF POISONOUS DRUGS 

the States except Nevada, New Mexico, South Dakota, 
Delaware, and Vermont have followed the example 
of Illinois in regard to cocaine, all except seventeen 
States have placed a similar restriction on the sale of 
opium and morphine or both, and fourteen States have 
placed the same ban on chloral hydrate. Since 1912 
further important State legislation has been passed. 

The use of these drugs by habitues is, however, 
constantly on the increase, and it is now a recognized 
fact that only rigid Federal legislation can cope with 
the situation. A Federal statute passed in 1909 
forbids the transportation of cocaine in the mails 
and prohibits the importation of opium, its prepara- 
tions and derivatives, except for medicinal purposes. 

A Federal statute commonly known as the Harrison 
Act went into effect on March 1, 1915, which is 
intended to restrict the use and sale of opium and 
coca and their preparations and derivatives. By this 
law every person who is concerned with the handling 
of these drugs, importing, manufacturing, selling and 
prescribing, must register with a United States revenue 
collector and pay a tax of one dollar a year. Even 
when registered such persons must keep a record of 
every sale of these drugs and give a duplicate to the 
purchaser. All records must be open for inspection 
for two years. 

A prescription containing any one of these drugs 
beyond certain limits can be lawfully filled only when 
it conforms to the following requirements: (1) it must 
be signed by a physician registered under this Act, 
giving his name in full, his address and registry number; 



LEGISLATION OF POISONOUS DRUGS 265 

(2) it must state the name and address of the person 
for whom it is prescribed; and (3) it must be dated 
on the day on which it is signed. 

It is unlawful for anyone not registered to have these 
drugs in their possession except a nurse or other per- 
son under the order of a physician who has registered 
or a person who has obtained the drug by a prescription 
written as stated above. The penalties for breaking 
this law are a fine of not more than $2000, imprisonment 
of not more than five years or both. This Federal 
Act does not render invalid preexisting laws which 
are wider in scope. 

Another important recent Federal statute in regard 
to drugs is the so-called Pure Food and Drugs Act 
which went into force in January, 1907. This law is 
aimed especially at adulteration and misbranding of 
drugs. According to its requirements in regard to 
adulteration, any drug sold under the name given in 
the United States Pharmacopoeia or the National 
Formulary must be up to the legal standard or any 
variation in the standard must be stated truthfully 
on the label. In regard to misbranding, this law 
penalizes false statements as to ingredients or place 
of manufacture, imitation of articles sold under another 
name, and the substitution of some other preparation 
for the original contents. It requires a statement 
on the label of the presence and quantity of the fol- 
lowing drugs: alcohol, morphine, opium, cocaine, 
heroin, alpha- or beta-eucaine, chloroform, cannabis 
indica, chloral hydrate, acetanilid, and any deriva- 
tives or preparations of these drugs. 



266 LEGISLATION OF POISONOUS DRUGS 

On the statutes of practically every State and 
territory of the United States is a list of substances 
which under the law in that district are considered 
poisons. This list is frequently in two parts, one 
including substances the sale of which must be 
recorded, and the other those which must be labelled 
"Poison." In most cases the pharmacist is also 
required by law to question the purchaser as to his 
knowledge of the nature of the drug and as to his 
object in buying it. The drugs the sale of which has 
to be recorded are usually those most often used for 
suicide or murder: arsenic, the salts of mercury, 
hydrocyanic acid (prussic acid) and its salts, strych- 
nine, oil of bitter almonds (contains prussic acid), 
and phenol. The list of drugs which have to be labelled 
"Poison" includes many which cause corrosion, abor- 
tion, or death in overdoses. This list varies very 
much in different States but nearly always includes 
aconite, belladonna, digitalis, colchicum, conium, 
nux vomica, cantharides, croton oil, mineral acids, 
oxalic acid, white precipitate, cotton root, ergot, 
savia, and some of the salts of zinc and lead. 

A nurse should remember that she comes under the 
law in purchasing poisonous drugs even if she does 
have more thorough knowledge of their character and 
use and must not expect a pharmacist to make him- 
self liable to fine, loss of license, and even imprisonment 
by selling her drugs illegally. It should be a matter 
of honor for every nurse to cooperate with the pharma- 
cist in upholding the law. 



PART VI. 

OTHER THERAPEUTIC MEASURES. 



CHAPTER XXVI. 
PSYCHOTHERAPY. 

Psychotherapy may be defined as any method of 
treatment by which the condition of the brain can be 
favorably changed and thereby general physical and 
mental conditions improved. The method varies with 
the doctor and with the patient. 

As the brain has within its convolutions areas which 
control every organ and function it can influence 
conditions in every part of the body. There is no 
state of the brain which does not in some way affect 
the body and disease of the body often affects the 
brain. 

When the brain receives at the same time two 
contrary impressions it reacts to the stronger. For 
example, when it receives an impression of joy together 
with one of pain from a diseased organ it will react 
to the one which is most intense. It is then understood 
why a sunny room, a cheerful voice, a happy face, 



268 PSYCHOTHERAPY 

and enjoyable occupation help to lessen suffering. The 
object in all psychotherapeutic treatment is (1) to 
occupy the brain with feelings contrary to those in 
other parts of the body and (2) to increase its control 
over the bodily functions. 

The greatest factors in giving strength to the brain 
are faith and what has been called by Dr. Cabot 
"expectant anticipation." A strong belief that a 
special type of treatment is to be a means of cure 
actually stimulates the brain and as a result gives 
tone to the nerves, bloodvessels, heart, and muscles. 
It matters little what the object of the belief may be: 
a charm carried in the pocket, an image or relic of a 
saint, a benediction by some eminent person, a prayer, 
a prescription, Christian Science, a quack, or some 
trusted physician. This explains the efficacy of bread 
pills, placebos, and powders of saccharum lactis, and 
the importance of confidence in the physician on the 
part of the patient. Faith is a first essential to the 
success of any psychotherapeutic treatment. 

The methods by which conscious effort is made on 
the part of the physician to reestablish control by the 
brain may be classified as suggestion through the 
agency of hypnotism, suggestion without hypnotism,, 
and reason. 

In hypnotism the patient is put into a condition of 
actual sleep, unlike natural sleep in that he will respond 
to commands and retain the power to obey them after 
awakening. While in this state he is given the neces- 
sary commands for his recovery. For example, in a 
case of alcoholism the physician tells the hypnotized 



PSYCHOTHERAPY 269 

patient that he does not like alcohol and will not want 
it any more. By this method after one or more treat- 
ments the physician himself works the cure, the patient 
being unconscious and passive. In treatment by sug- 
gestion without hypnotism the patient is brought to a 
quiescent state by being subjected to all kinds of 
soothing influences and while passive but fully con- 
scious is told plainly and emphatically the causes of 
his troubles, the manner in which they will disappear, 
and what he must do to help in his recovery. By 
this method months are usually required of persistent 
and patient persuasion and argument to reestablish a 
normal state of the brain. In this form of treatment 
the patient must cooperate with the physician. Reason 
alone can be used as a form of treatment with patients 
who in health have a high degree of intelligence and a 
strong will-power. In this form of treatment the 
patient is emphatically and persistently given plain 
truth in regard to his condition and its causes, and 
advice along very definite lines as to his cure. He is 
then left to work out his own cure under guidance. 

It is of greatest importance that psychotherapeutic 
treatments should be accompanied by all kinds of 
hygienic measures, such as cold baths, exercise, and 
sleeping in well- ventilated rooms. The duty of the 
nurse caring for such a case is to see that these measures 
are systematically carried out. She must keep the 
patient from brooding over himself, use every means 
to encourage him, make his prescribed duties as easy 
as possible, and by every means strengthen his will- 
power. 



270 PSYCHOTHERAPY 

Psychotherapy has special application in functional 1 
diseases of the nervous system and in alleviating the 
symptoms of certain organic ones. The conditions 
most often treated are pain, insomnia, nervous irri- 
tability, melancholia, phobias, obsessions, 2 neuras- 
thenia, moral laxity, spasm, nausea, alcoholism, and 
drug habits. 

Music is a most efficient aid to psychotherapy. 
To most people it is a pleasing mental diversion and 
it has been proved by experimentation to have a 
distinct effect on the higher nerve centres varying 
according to the style of music. Quick martial music 
is a stimulant, a dreamy nocturne a sedative. Through 
the ages the value of music as a therapeutic agent has 
been recognized and there are instances of cures of 
melancholia by music when all other measures have 
failed. A professor of experimental psychology in 
Johns Hopkins University, in an address to a body 
of nurses, made the statement that every woman who 
devotes her life to nursing should be able to sing to 
her patient. 

Psychotherapy has been slow in taking a definite 
place in medicine partly because of its bad reputation 
from association with quackery. Any person with a 
little knowledge of this art, a knack in applying it 
and an insight into human nature can practice quack- 



1 In a functional disease the tissues of an organ are intact but the 
nerve control is lost. 

2 A mental disorder in which a person is controlled by some strange 
idea or fear. An example is a case of a woman who was afraid she 
would walk in her sleep and could not sleep unless she were tied 
securely to the bed. She was cured by mental treatments, 



PSYCHOTHERAPY 271 

ery and undoubtedly perform some cures. It is 
estimated that in New York City there are 20,000 
quacks to 6000 registered physicians. The appalling 
side of quackery is that it attempts to cure every ail- 
ment regardless of its cause and that every applicant 
is made to feel that he has some serious disease which 
can be cured on payment of a correspondingly large 
fee. 



CHAPTER XXVII. 
HYDROTHERAPY. 

Hydrotherapy is the art of treating disease by 
means of water. Hydriatric is an adjective in com- 
mon use as a substitute for hydro therapeutic. 

The father of modern hydrotherapy is Dr. Wilhelm 
Winternitz, now an old man, professor emeritus of the 
University of Vienna. Dr. Simon Baruch, the highest 
authority and leading advocate of water as a thera- 
peutic agent in the United States, pays him tribute 
by stating that to him medical science owes nearly 
all it knows about the scientific use of water. Besides 
his work in original research he was a great teacher, 
wrote two hundred books and monographs, and 
created the first hydrotherapeutic clinic in Vienna at 
his own expense. In spite of his efforts little attention 
was given to this form of treatment until a quack, 
Father Kneipp, a Bavarian priest, established a water 
cure which became so popular that regular medical 
practice was seriously affected financially. Steps were 
then taken to give hydrotherapy a place in medical 
schools and clinics in Austria and Germany. Largely 
through the efforts of Dr. Baruch in this country the 
value of hydrotherapy has become well recognized 
here, and definite principles of method and dosage 
have been worked out. 



HYDROTHERAPY 273 

The conditions in which water is a useful therapeutic 
agent are almost unlimited because it may be used 
as ice, water or steam; it may be given internally, 
hot or cold; and applied externally, hot or cold, in 
baths, packs, stupes, douches, all kinds of sprays, 
irrigations, and in bags and coils. It may serve, 
according to the method of application, as a nerve 
sedative or stimulant, a heart stimulant, a means of 
altering the circulation, a stimulant to the skin, a 
diaphoretic, a laxative, a hemostatic, a counter- 
irritant, and a general tonic. 

Internal Use. — The value of water internally is gen- 
erally recognized as a food, a cathartic, a diuretic, and 
a diluent. It is quite possible, however, to drink too 
much water. Large quantities of hot water taken 
over a long period cause dilatation of the gastro- 
intestinal tract; excessive amounts of cold water 
over a long period may cause a general edema. 

External Use. — The external application of water 
at or near the temperature of the skin (about 90° F.) 
produces no effect. All therapeutic action depends 
on the difference in the temperature of the water and 
the skin and varies directly with the amount of differ- 
ence. When water is mentioned as a therapeutic 
agent it is assumed to be sufficiently hot or cold to 
produce some effect. 

Action. — Cold, heat, and an impact against the skin 
are all irritants to the sensory nerve endings of the 
skin. By reflex action the nerve centres are stimulated 
and a general improvement follows in the organs and 
tissues of the body. These same factors, especially 
18 



274 HYDROTHERAPY 

cold, cause the capillaries to contract, sending more 
blood to the large arteries, and increasing the force 
of the heart. When the cold or other cause is removed 
the capillaries dilate, they are then rapidly rilled with 
blood, and a redness or glow of the skin results. This 
is known as the " reaction" and is proof of the restora- 
tion of an active circulation. 

Factors which Determine Action.- — In general the 
degree of stimulation and of reaction vary directly 
with (1) the temperature of the application; (2) its 
duration; (3) the extent of surface treated; (4) the 
force of the impact ; (5) the susceptibility of the patient ; 
(6) the amount of friction during and after the treat- 
ment. 

1. Temperature. — The following shows the effect in 
general of the varying temperatures: 1 

Bath. Temperature. Effect. 

Overstimulation fol- 
lowed by fatigue 
Cold . . 40°- 65° F. ( 4.4°-18.3° C.) { or even collapse. 



Cool . 
Tepid . 
Warm 
Hot . 
Very hot 



Hemostatic. 

65°- 75° F. (18.3°-23.8° C.) \" Q ,. , .. 

85°- 95° F. (29.4°-35.0° C.) / Stimulation. 

95°-100° F. (35.0°-37.7° C.) Sedative. 
100°-110° F. (37.7°-43.3° C.) Stimulation. 
1 10 °-120 ° F. (43 . 3 °-48 . 8 ° C.) Hemostatic. 



2. Duration. — A cleansing or stimulating bath 
should not last more than three to five minutes. In 
health a regular practice of prolonged baths or of 
bathing more than once a day tends to be debilitating 
and may cause nervousness and loss of weight. The 
effect of a continuous hot bath (about 100° F.) without 

1 Temperatures from Hinsdale's Hydrotherapy. 



HYDROTHERAPY 275 

friction is to reduce the blood supply of the brain 
and sooth the nerves. This form of treatment is 
much used to relieve insomnia and to quiet the insane. 
For insomnia a bath of ten to thirty minutes may be 
prescribed; in the case of the insane it may be con- 
tinued from one or two to twenty-four hours. 

3. Extent of Surface. — When cold water or ice is 
continuously applied over a small area, as in a bag 
or coil, it is usually for the purpose of contracting the 
bloodvessels at the point of application to reduce an 
inflammation or to check hemorrhage. The purpose 
of a cold compress is the same as that of a cold bath 
or pack confined to a limited area; that is, to get a 
vigorous reaction at that point in the superficial 
bloodvessels and thus relieve a deeper congestion. 
As the purpose of cold compresses is to increase heat 
loss they should never be covered with oiled or rubber 
cloth which are non-conductors of heat. Hot local 
applications dilate the capillaries and likewise act as 
a counter-irritant. Local treatments of this kind may 
produce some change in the force or rate of the heart 
beat but for general stimulation half or full immersion 
or spray baths are used. 

In regard to the last three factors named above, it 
is commonly known that an increase in the force of the 
impact of the water, the susceptibility of the patient, 
and the amount of friction will produce correspondingly 
greater stimulation and better reaction. 

Cold Baths. — The purpose of cold baths in any form 
is stimulation. Their use in fevers is to increase the 
patient's power of resistance by stimulating the nerves 



276 



HYDROTHERAPY 



and heart — only incidentally to reduce the temperature. 
The regulation of the temperature of the water and 
the use of friction are most important in such cases for 




Fig. 21. — Portion of douche room, Michael Reese Hospital, 
Chicago, showing control table of Mott type (foreground) and com- 
bination douche (background) where the patient stands during 
treatment, 



HYDROTHERAPY 277 

without a good reaction the baths are a distinct harm. 
It is also essential that the patient be thoroughly 
warm before the bath, that the bath be given in a 
warm room, and, in the case of bed patients, that ice 
cloths or an ice-bag be kept on the head. Cold baths 
are given (1) to bed patients in the form of sponge 
baths, slush baths, and wet packs; (2) in tubs by 
pouring water from pitchers over the patient while 
standing or sitting in water or by drip sheets; and 
(3) by various kinds of douches, jets, and showers 
directed from a control table. This control table is 
so constructed that the operator can regulate the form, 
direction, temperature, and force of the water. Some 
of the common forms used are the jet douche, a small 
stream under pressure; the Scotch douche, alternat- 
ing hot and cold ; the rain douche, a stream from above ; 
a fan douche, produced by placing the finger over the 
nozzle of a jet; and a circular douche, in which the 
water strikes at an angle and the patient turns slowly 
around. Usually as a preliminary to douche treat- 
ments the patient is placed in a hot-air or electric-light 
cabinet to get him thoroughly warm. A typical pre- 
scription for hydrotherapeutic treatment is given in 
full. In practice abbreviations are used. 

Hot-air baths: until perspiration starts. 

Circular douche: 2 min., 105°-90° F. (40.6°-32° C), 20 lbs. 

Jet douche: 1 min., 100°-80° F. (37.8°-26.7° C), 20 lbs. 

Scotch douche: 20 sec, 105° and 80° F. (40.6° and 26.7° C), 20 lbs. 

Fan douche: 10 sec. at 78° F. (25.6° C). 

Alcohol rub. Reduce minima 1 ° daily to 60° F. (15.6° C). 

Such treatments are used as general tonics in anemia, 
nervous disorders, general debility and in weakening 
diseases like tuberculosis. 



278 HYDROTHERAPY 

Balneology. — Balneology is a term applied to the 
use of mineral waters in disease. Mineral waters have 
a wide reputation both for internal and external use. 
When taken internally they have the same action as 
the mineral ingredients which they contain. For 
example, chalybeate waters (those containing iron) 
are useful in anemias, arsenical waters for scrofula and 
anemia, alkaline waters for rheumatism and gout, 
sulphur waters for skin and liver diseases, bromo- 
iodin waters for skin diseases and goitre, saline waters 
as cathartics. It is now an established fact that 
these waters in the form of baths have no more sys- 
temic action than plain water with the exception of 
those which are strongly saline and effervescent. 
Strongly saline water and carbon dioxide gas are 
irritating to the skin and by reflex action cause some 
general stimulation. A strong saline bath is called a 
brine bath; a strongly effervescent one, a sprudel 
bath. Some of the mineral waters are undoubtedly 
radio-active and are thus more stimulating. The 
change, rest, diet, diversion and routine life of a 
spring resort are large factors in the recovery of a 
patient. At the more famous resorts are doctors who* 
have become very skilful in combining the various 
hydro therapeutic treatments with other hygienic 
measures so that the maximum benefit is derived from 
both. 

In the United States there are 2800 spring localities 
and about 9000 individual springs. The most impor- 
tant resorts are at Hot Springs, Arkansas; Hot Springs, 
Virginia; Saratoga and Richfield Springs, New York; 



HYDROTHERAPY 279 

Mt. Clemens, Michigan; and French Lick and West 
Baden, Indiana. The best-known foreign resorts are 
Nauheim, Baden-baden, Aix-la-Chapelle and Hamburg 
in Germany; Carlsbad in Austria; Bath and Buxton 
in England; Aix-la-Bains in France; and Helouan- 
les-Bains in Egypt. Some of the resorts specialize 
in certain diseases, as, for example, Nauheim in heart 
diseases, Buxton in gout, West Baden, Indiana, in 
alcoholism and cases of drug habit, and various hot 
spring resorts in rheumatism. Syphilitic cases are 
treated at certain springs, the baths enabling the 
patient to bear excessive mercurial medication. The 
value of Nauheim baths in heart cases is to a great 
extent due to carefully prescribed gymnastic exercises. 
Concentrated salts are exported from Nauheim and 
other springs for use in making artificial baths. 

Other Baths. — A new form of bath is one in which 
the water is charged with oxygen, little bubbles of 
which gather all over the patient's body. The action 
is to reduce a high blood-pressure and a high rate of 
respiration and pulse. 

A Turkish bath consists of a hot-air bath, until 
there is free perspiration, followed by massage and, 
lastly, a cold plunge and swim. This is beneficial in 
gout, dyspepsia, obesity, and alcoholism. 

A Russian bath accomplishes the same result by 
means of a hot-steam bath followed by a cold plunge. 

Baths in mud, peat, and fango (volcanic mud) are 
beneficial simply as a method of applying heat, and are 
used in rheumatism, gout, arthritis, and neuralgias. 



CHAPTER XXVIII. 
ELECTROTHERAPY. 

Electrotherapy is the use of electricity as a 
therapeutic agent. The action of electricity when 
applied to living tissues is to cause general stimulation 
or depression, to produce heat, and to bring about 
chemical changes in the cells. These chemical changes 
may be any one of three distinct kinds; a rearrange- 
ment of ions, 1 a displacement of ions, or the introduction 
of new ions from outside. 

There are three types of machines in common use 
for the generation of electricity and their respective 
currents have distinctive characteristics and special 
uses in medicine. They are known as static, galvanic, 
and faradic according to the method of generation. 

Static Electricity. — Static machines generate elec- 
tricity by the revolution of a series of disks, alternate 
disks revolving in opposite directions (Fig. 22). 

For treatment by static electricity the patient is 
placed on an insulated stool, that is, one so made that 
a current of electricity cannot pass from it to the floor. 



1 It is generally held by chemists that certain substances when in 
solution dissociate into their constituents — either elements or radi- 
cals. Each of these constituents, being electrically charged, is 
termed an ion. Ions are either negative or positive according to 
the charge that the carry. 



STATIC ELECTRICITY 



2S1 



In local treatments the affected part is sometimes 
exposed but ordinarily the patient may be fully dressed. 




Fig. 22. — Wimshurst machine. (Potts.) 



The current is carried to him from the machine by 
means of chains or insulated wires. One electrode 1 is 

1 An electrode is here understood to mean the part of the apparatus 
which comes in contact with the patient. By means of the two 
electrodes the patient becomes a part of the circuit through which 
the current of electricity passes. 



282 



ELECTROTHERAPY 




placed in the patient's hand or under his feet and the 
other on some other part of the body. 

If while the patient is subjected to the current a 
third electrode is held near him a sensation is felt like 
a breeze from that electrode. This is called an electric 
breeze or brush discharge and it is used as a sedative 
to painful superficial nerves 
and certain itching skin dis- 
eases and as a stimulant to 
chronic ulcers and certain 
chronic skin diseases. 

If this third electrode be 
held quite near, sparks will 
pass from it to the patient 
which cause muscular con- 
traction at the point of con- 
tact. The effect produced 
depends upon the size of the 
spark, small ones acting as a 
sedative, large ones causing 
severe contractions of the 
muscles and invigoration. 

Galvanic Electricity — Gal- 
vanic electricity is generated 
by a galvanic cell (Fig. 23). 
One cell does not produce enough electricity to affect 
the human body, so a series of cells, from 20 to 30, 
are connected forming a galvanic battery (Fig. 24). 
The strength of the current is regulated by the num- 
ber of cells. 

The electrodes of a galvanic battery are always 



Fig. 23. — Galvanic cell: 
A, containing jar; B, fluid; 

C, bar of zinc, called the 
negative pole because the 
current enters the cell here; 

D, bar of copper, platinum, 
or carbon, called the posi- 
tive pole because the cur- 
rent leaves the cell at this 
end; E, the ends which 
would be applied to the 
patient. Dry cells are 
made by substituting a 
damp chemical powder for 
the fluid and are now much 
used. 



FARADIC ELECTRICITY 



2S3 



padded to avoid burns and when in use they are kept 
wet with sodium bicarbonate or chloride. The skin is 
also kept wet, but even then it must be watched to 
avoid blisters. One electrode is placed over the 
affected part; the other at the back, abdomen, feet, or 
hands so that the two are a long way apart. For 
treatment of the whole body, galvanic electricity may 




Fig. 24.— Keystone portable galvanic battery. (Potts.) 

be given in an electric bath, that is, the patient or one 
or more of his extremities are fully immersed in warm 
water and electricity is conducted into the water. 

Faradic Electricity.— Faradic electricity, named from 
its discoverer, Prof. Faraday, is generated by what is 
called an induction coil (Fig. 25). An induction coil 
is a reel of insulated copper wire containing an iron 
core and a second reel of wire over the first, separated 



284 



ELEC TRO THERA P Y 



from it by hard rubber. A current of electricity from 
a galvanic battery is passed through the reels of copper 
wire. By it the iron core temporarily magnetizes them 
and the original current is transformed to one espe- 
cially adapted to medical treatment, that is, it has a high 
degree of activity to a comparatively small amount of 
current and has a high degree of penetration. 




Fig. 25. — Induction coil: E, primary coil; F, secondary coil slid 
to the right to show the primary coil; P, wires conveying current 
to the patient from the primary coH; S, from the secondary coil; 
G, the end of the iron core. To the left of the coils is apparatus 
which makes and breaks the current on the way to the patient. 
(Sturridge.) 



The two reels are not used at the same time. The 
inner one produces what is called the primary current, 
the outer one the secondary current. The first is used 
especially for treatment of deep-seated organs; for 
example, the intestines in chronic constipation. The 
secondary current is of special use in treatment of 
the limbs and the skin. 

Faradic treatment is conducted in the same manner 



TYPES OF ELECTRICAL CURRENTS 



285 



as galvanic except that the pads are wet in tepid water 
alone. It is very frequently given in the form of full 
immersion baths. 

Types of Electrical Currents. — The currents of elec- 
tricity obtained from these machines are of three 
distinct types: continuous, interrupted, and alternat- 
ing. They are expressed graphically below (Fig. 26). 



A. Continuous 



B. Interrupted 




C. Alternating 




D. Sinusoidal 
Fig. 26. — Graphs of types of electric currents. 



A continuous current may be compared to a steady 
flow of water which does not vary in force. An inter- 
rupted or intermittent current is made from other 
kinds by special apparatus which at regular intervals 
makes and breaks the original current. An alternating 
current is one which varies periodically both in force 



286 ELECTROTHERAPY 

(B) and direction (C). The sinusoidal current is a 
special type of an alternating current which has a 
high degree of penetration. The frequency of a cur- 
rent means the number of waves per second. A low- 
frequency current has a small number, a high fre- 
quency several thousand. 

The choice of current for treatment of different 
diseases varies very much with the operator. Muscu- 
lar contractions are caused by an interrupted current, 
one of low frequency, and by a sudden increase or 
decrease in the force of a current. Such an action is 
desired in diagnosis to determine the origin and degree 
of a paralysis and as a therapeutic agent to restore 
an atrophied or weak muscle by mechanical exercise. 
Continuous and high-frequency currents are com- 
monly used to stimulate the nervous system and to 
increase metabolism and elimination. Some of the 
conditions in which good results have been obtained 
are neurasthenia, neuralgia, anemia, general debility, 
paralysis, chronic rheumatism, and phthisis. High- 
frequency currents are often used in connection with 
.T-ray treatments in gynecology to promote the absorp- 
tion of exudates and abnormal growths. They are 
in some cases employed purely for their heat effect. 
This form of treatment is called diathermy and is 
employed in headaches, neuralgia, rheumatism, loco- 
motor ataxia, tic douloureux, deafness, eye affections, 
and as a caustic. 

Electricity may be employed by means of needles 
to remove birth-marks and other blemishes. In cases 
of obesity its use is based on the theory that the 



CATAPHORESIS 287 

muscular contractions caused by the currents take the 
place of excessive exercise for those who because of 
a weak heart cannot endure normal physical exercise 
or a reduced diet. 

Most electrical treatments last from ten to fifteen 
minutes and are repeated two or three times a week. 

Cataphoresis. — A more recent use of electricity in 
medicine is to introduce drugs into the body through 
the skin. This is called cataphoresis or ionic medica- 
tion. By this method the drugs probably are intro- 
duced directly into the cells and do not enter the cir- 
culation. The procedure is to place over the affected 
part pads saturated with a solution containing the 
desired ion and place the electrode over the pad. The 
choice of electrodes is very important because the 
different poles cause different ions to enter the body. 
Examples of ions used in this way are zinc ions for ulcers 
and fistulas, quinine and salicylic acid for rheumatism, 
iodine and lithium in gout, chlorine to soften scar 
tissue, and cocaine for local anesthesia. Electric 
baths have been tried with some success in cases of 
lead poisoning in an attempt to promote excretion of 
the lead ions from the body. 

Administration of electrical treatments requires a 
highly specialized training by both the doctor and the 
nurse who assists him. A nurse who intends to enter 
this field must acquire a good understanding of the 
science of electricity and of electrical machines. To 
win success she must be thorough, exact, and accurate 
in her work, capable of careful and maintained atten- 
tion, and not easily excitable. 



CHAPTER XXIX. 
SERUMS AND VACCINES. 

A therapeutic serum is blood serum either in its 
normal state or one which contains immune substances. 
The use of normal serum as a hemostatic has already 
been discussed (page 162). 

Preparation. — An immune serum contains large quan- 
tities of protective antibodies against some pathogenic 
bacterium. It is given to a patient infected by that 
same bacterium to supplement his own antibodies. 
This process is called passive immunization. All 
immune serums are prepared by inoculating some 
animal with the microorganism against which immun- 
ity is desired until the animal's blood contains the 
maximal amount of antibodies. This is then with- 
drawn and its serum prepared for therapeutic use. 

A vaccine is an emulsion of dead or attenuated 
bacteria in normal saline solution. The bacteria are 
cultivated on living tissue or in some culture medium. 
The action of a vaccine as a therapeutic agent is to 
stimulate the human organism to manufacture its own 
antibodies. This is known as active immunization. 

Therapeutic Use.— In general it may be stated that 
vaccines are of special use for prophylactic purposes 
and as cures in infections which tend to become chronic, 



ACTIVE IMMUNIZATION FOR PROPHYLAXIS 289 

such as gonorrheal infections, infections of the bones, 
joints and sinuses, and chronic inflammation of the 
ear. Serums are of greatest value in acute dis- 
eases when there is not time for the body to manu- 
facture a sufficient quantity of its own protective 
antibodies. Some are also efficacious as prophylactics. 
Administration. — With the exception of smallpox 
vaccine, vaccines and serums are given by hypodermic 
injection into various portions and tissues of the 
body. The procedure is the same as in any hypo- 
dermic injection except that the skin is usually sterilized 
by painting with tincture of iodine before the injection. 

ACTIVE IMMUNIZATION FOR PROPHYLAXIS. 

1. Smallpox Vaccine. — The method by which this 
vaccine is introduced is well known. Usually one 
vaccination is sufficient to produce immunity for a 
period of at least seven years but in case of an epi- 
demic revaccination is advisable if more than a year 
has elapsed. 

2. Rabies Vaccine. — This vaccine is an emulsion in 
water of a piece of the medulla of a rabbit which died 
of rabies. It is usually injected into the abdomen 
daily for about six or eight days. Vaccine of increas- 
ing virility is used on the successive days. Immunity 
lasts only a few weeks. 

3. Typhoid Vaccine. — Usually three injections are 
given about a week apart. Immunity lasts from 
one to three years. 



19 



290 SERUMS AND VACCINES 

ACTIVE IMMUNIZATION AS A CURE. 

Attempts to use the before-mentioned vaccines as 
cures have not met with any degree of success. The 
most commonly known vaccine used in an attempt 
to cure is Koch's Old Tuberculin and Neu (new) 
Tuberculin for tuberculosis. The first has now been 
practically discarded. The results obtained from the 
last are extremely variable and its use at best is limited 
because of the difficulty in regulating the dose to 
avoid its toxic actions. The best results have been 
secured in institutions where the patient can be 
thoroughly studied and kept under control. 

PASSIVE IMMUNIZATION. 

1. Diphtheria Antitoxin. — This is a horse serum 
containing the antibody antitoxin, which neutralizes 
the toxin excreted by the Klebs-Loffler bacillus just 
as an alkali neutralizes an acid. It is given every 
twelve to twenty-four hours until acute symptoms 
subside, and an early injection will practically abort 
these symptoms. In extreme cases it may be given 
intravenously. This serum has been standardized so 
that a unit is a quantity capable of neutralizing 100 
units of toxin. 1 The average Curative dose is 3000 
units, for prophylactic purposes 500-1000 units. 

2. Tetanus Antitoxin. — This serum has been proved 
most efficacious as a prophylactic but until very 
recently has been regarded of little or no value after 

1 A unit of toxin is the amount required to kill a 250-gramme 
guinea-pig in 4 to 5 days. 



PASSIVE IMMUNIZATION 291 

the tetanic symptoms have appeared. From recent 
research this failure seemed to be due to a wrong 
method of injection and to the use of too small doses. 
The tetanus microorganism multiplies in the infected 
wound and liberates toxins which enter the circulation 
but to a larger extent pass along the nerve trunks to 
the spinal cord where they accumulate in large amounts. 
When the antitoxin is given subcutaneously its action 
is very slow in the circulation and it cannot readily 
reach the toxins along the nerves or in the cord. For 
prophylaxis this method may be successful in slowly 
developing cases but as a cure it is a failure. Two 
experimenters, Park and Irons, have recently concluded 
that for curative purposes the antitoxin must be 
administered intraspinally, intravenously, or by both 
channels at once. Intraspinal injections are usually 
given under an anesthetic. Tetanus antitoxin has 
been standardized by the United States government, 
but no definite dosage has yet been established. For 
prophylactic purposes about 3000 units are given sub- 
cutaneously. After tetanic symptoms have begun the 
experimenters mentioned above advise as a curative 
dose, 3000-5000 units intraspinally and 10,000-20,000 
units intravenously at the same time, a second intra- 
spinal dose after twenty-four hours, and after four or 
five days, 10,000-15,000 units subcutaneously to 
maintain the protection for several days longer. 
Immunity lasts at most only a few weeks. 

3. Meningitis Antiserum. — The popularization and 
perfection of this important serum is the result of work 
bv Dr. Simon Flexner of- New York. It contains 



292 SERUMS AND VACCINES 

various antibodies, agglutinins, precipitins, bacterio- 
lysins, and others, and their action is to check the 
multiplication of the meningitis organisms and to 
increase the activity of the phagocytes. They are 
injected intraspinally as a means of cure. 

OTHER SERUMS AND VACCINES. 

There are many remedies of this type which are 
still in the experimental stage or which are not in very 
general use. Good results have been obtained from 
cholera and plague vaccines and from antivenene, a 
prophylactic serum against poisoning from venomous 
snake bites. The last is regularly used in military 
hospitals in India and is efficient if injected within 
eighty to ninety minutes after the bite. Reports from 
the use of antipneumococcus, antigonorrheal, anti- 
whooping-cough, antidysentery, and antistreptococcus 
serums show varying results. The last has been used 
in scarlatina, erysipelas, septicemia, and streptococcus 
infections of the nose and throat. 

There are several preparations on the market called 
phylacogens for rheumatism, gonorrhea, erysipelas, 
pneumonia, and one for mixed infections. They are 
highly toxic mixtures of the products of the metabolism 
of certain pathogenic bacteria. They have not yet 
been endorsed by the medical profession. 

There are many failures in the use of serums and 
vaccines which are variously explained. The pre- 
paration may be poor; with only three exceptions 
there is no standard by which the dosage can be 



SERUM SICKNESS 293 

regulated; and the serum may be injected where it 
cannot readily and promptly reach the infection. 
Another reason for failure is that all vaccines and 
serums are specific in action against some one micro- 
organism and it may not be known what microorganism 
is present in the individual case. For example, pneu- 
monia may be caused by more than one form of pneu- 
mococcus, and for successful treatment the particular 
one present in any individual case must be determined 
and a serum against that one must be used. In the 
present state of serum and vaccine therapy this is 
not always possible. To overcome this difficulty 
stock vaccines are made containing a number of dif- 
ferent strains of pathogenic bacteria, true "shotgun" 
remedies. Such a vaccine has been recommended to 
produce immunity against common head colds. To 
secure specific action vaccines called autogenous vac- 
cines are made from cultures taken from the blood, 
sputum, urine or pus of the infected patient. This 
is probably the only rational method. 

SERUM SICKNESS. 

Often following the administration of serum a 
reaction occurs, that is, certain symptoms arise that 
are caused by the serum, such as fever, headache, 
edema, asthmatic conditions, and even collapse. This 
reaction is now known to be an example of anaphylaxis. 
Anaphylaxis is defined as the phenomenon following 
the introduction of a soluble protein (by means other 
than through natural channels) into the circulation of 



294 SERUMS AND VACCINES 

an animal previously sensitized to this protein. The 
method by which a person becomes sensitized is not 
always known. Anaphylaxis may lead to serious 
results and as a precaution a physician may inject 
very small amounts of the serum at first to determine 
to what extent a patient may be sensitized or to 
create an anti-anaphylactic state. Previous serum 
treatments, asthma, hay fever, and an idiosyncrasy 
to the exhalations of horses are conditions which 
indicate the need of care in giving a serum. A state 
of hypersensitiveness may last for seven years. 

In 1902 a Federal law was enacted under which the 
Public Health Bureau of the United States govern- 
ment supervises the manufacture and interstate sale 
of vaccines, serums, and other biological products. 
The government license certifies approval of the 
technique of the process, the sanitary conditions of 
the laboratories, and the care of the animals, and 
requires certain facts printed on the label of the pro- 
ducts, but it is not a guarantee of therapeutic worth. 
The government has no control over worthless products 
except as imports or in interstate sales. Smallpox 
vaccine and diphtheria and tetanus antitoxins are 
standardized, and antirabic serum has recently been 
distributed from Washington for treatment outside of 
the Pasteur Institutes. 



CHAPTER XXX. 

RAY THERAPY. 

The scientific use of various kinds of rays in the 
treatment of disease has recently come to form a 
distinct branch of therapeutics. Some of the terms 
in common use to designate special forms of ray 
therapy are: heliotherapy, the use of the sun's rays; 
chromo therapy, the use of colored light; Rontgen- 
therapy, the use of z-rays or Rontgen rays; and 
radiotherapy, the use of various kinds of rays. 

HELIOTHERAPY. 

It is not difficult to understand why the sun was 
worshipped as the source of life by primitive peoples 
because it was and is a matter of common observa- 
tion that vegetable and animal life wilt in the dark 
and thrive in the sun. It is only within the last 
twenty years, however, that efforts have been made 
to develop a systematic method of using the sun as 
a therapeutic agent and to separate the different kinds 
of rays in sunlight for special uses. 

The first series of observations as to the effect of 
sunlight on disease was made by Dr. Loncet of Lyons, 
France, about 1890-1900, in cases of tubercular affec- 
tions of the joints. He obtained excellent results, some 



296 RAY THERAPY 

of which were almost miraculous, and became convinced 
that the benefit extended also to the internal organs. 
In 1911 Dr. Rollier, a Swiss physician, followed Dr. 
Poncet's method under very different climatic con- 
ditions with equally good results. 

Strong sunlight is an irritant to the skin drawing the 
blood to the surface. It is bactericidal, it causes an 
increase in the number of red corpuscles and in the 
hemoglobin in the blood, and it may by reflex action 
stimulate the internal organs. Whatever the method 
of action, it is a fact that exposure of the naked skin 
to the sun is a valuable and easily available thera- 
peutic agent in anemias, general debility, acute 
muscular rheumatism, and especially in all forms of 
external tuberculosis. This, like any other remedy, 
should be used systematically and should be taken 
under advice, as too great exposure causes loss of 
weight, nervousness, and other bad results. 

The physical phenomenon known as light is a sensa- 
tion caused by the movements of ether waves on the 
organs of sight. These waves are of varying length, 
and the length of the wave determines the color of the 
object from which it comes to our eyes. Short waves 
produce a violet color, long waves a red color, and 
between these two are all the elementary colors. When 
waves of all lengths are mixed together the sensation 
on our eyes is white or absence of color. If a beam 
of light passes through certain substances, such as a 
drop of water or a prism, the individual rays are 
refracted (bent) at different angles and thus may be 
divided into the different colors according to the 



HELIOTHERAPY 297 

length of their waves. This is the way a rainbow is 
formed and may be diagrammed as in Fig. 27. This 
is called the spectrum of light. 

There are more rays on each side of the spectrum 
which under ordinary conditions are invisible. Those 
beyond the red are called the infra- or ultra-red 
rays or heat rays because they have the property 
of emitting heat. Those beyond the violet are called 
the ultra-violet, actinic or chemical rays as they 




Violet 



Fig. 27. — Diagram of the spectrum of light. 



have the property of affecting a photographic plate 
and of causing chemical changes in living tissues. 

Red glass is impermeable to ultra-violet rays and 
for this reason light admitted into a photographer's 
dark-room through red glass does not affect undevel- 
oped plates. This also explains the custom among 
certain primitive peoples of keeping smallpox patients 
in a room provided with red glass windows or of 
covering the face with red cloth to prevent deep 



298 RAY THERAPY 

pitting. It is now known that this is a rational 
procedure because by this means the irritating ultra- 
violet rays are screened from the sores. On this 
principle rooms with red glass windows have also been 
tried for cases of scarlet fever and measles with some 
success. 

Ultra-violet rays are in some cases desirable. They 
stimulate healing in chronic ulcers and as they are 
sufficiently active to be bactericidal they are used in 
treatments of lupus, eczema, and superficial malignant 
tumors and also for the purpose of sterilizing water. 

The electric arc light and the mercury vapor light 
(commonly seen in the popular night photo studios) 
are particularly rich in ultra-violet rays but any light 
may be used as a source by filtering out the red rays. 
Finsen, a Swedish physician, who is a strong advocate 
of light as a therapeutic agent, uses chiefly a powerful 
electric arc light. An apparatus used in medicine to 
obtain large amounts of ultra-violet rays is the con- 
denser spark lamp, in which the light is generated by 
electric sparks and the red rays are filtered out by a 
special lens. 

Electric-light cabinets are, as a rule, equipped with 
incandescent lights in which the heat rays predominate 
and are lined with mirrors or some highly polished 
metal for the purpose of reflecting the rays toward the 
inside of the cabinet. They are commonly used to 
produce sweating in such cases as chronic rheumatism. 
A portable electric-light bath has been devised for 
bedside use as a diaphoretic measure fully as efficient 
as a hot pack and much more agreeable to the patient. 



RONTGENTHERAPY 299 

RONTGENTHERAPY. 

The elaborate equipment of an .r-ray room is simply 
a means of providing an electric current for passage 
through a vacuum tube. In this way invisible rays 
called x- or Rontgen rays are produced. Modern 
vacuum tubes are modifications of the original vacuum 
tube used by Crookes, an English scientist, who first 
discovered in 1879 that rays are generated by this 
apparatus. Because they came from the cathode end 



art ode /----V^-V^;^ \ cat ft ode 




" r '''' 

X-rays catftode ra^ 

Fig. 28. — Diagram showing principles of x-ray tubes. 

of the tube he called them cathode rays. Fig. 28 
illustrates the principles of all vacuum tubes in x-ray 
work, Fig. 29 shows one type of a modern ar-ray tube. 
There are various devices in the new tubes for the 
purpose of maintaining a constant vacuum and auto- 
matically regulating the current. These tubes are 
very brittle and very expensive. 

Sixteen years after Crookes 's discovery Prof. Rontgen, 
of Germany, found other rays projected from the 
cathode rays (Fig. 28) which were very penetrating 
and which would photograph invisible objects, such 



300 RAY THERAPY 

as the bones in the human body and coins in a purse. 
He modestly named these new rays, .T-rays, but others 
called them the Rontgen rays from their discoverer 
whose name should rightly be associated with this 
agent which has come to be so important in modern 
medicine. 

The principle of .r-ray photography is the varying 
resistance of the different tissues of the body to the 
passage of the rays. For example, the bones are very 
resistant, hence the plate in that area is unaffected; 




Fig. 29. — Diagram illustrating the construction of a modern type 
of z-ray tube of American manufacture. (Potts.) 



the kidney is somewhat resistant, hence in that area 
the plate is slightly shadowed. z-rays themselves 
vary in their power of penetrating the tissues accord- 
ing to the degree of vacuum in the tube, the less 
penetrating rays being known as soft rays and the 
more penetrating as the hard rays. 

a>ray photography is today an invaluable means 
of diagnosis of certain conditions. By means of the 
plates foreign objects such as bullets, needles, and 
calculi can be located; fractures, deformities, and 



RONTGENTHERA P Y 30 1 

lesions of the bones and the condition of certain organs 
can be detected; and by introducing into the alimen- 
tary canal some substance which adheres to the 
mucous membrane and which does not transmit the 
.T-rays, the location and size of the canal can be seen. 
Apparatus has been devised by which a number of 
photographs can be taken in a minute so that the 
movements of the alimentary canal can be studied, 
and attempts are now being made to perfect a moving 
picture .T-ray machine. The interpretation of an 
x-ray plate is of greatest importance and requires 
the skill of an expert. 

When a-ray photographs are to be made of any 
part of the alimentary canal or of the kidney region 
the alimentary canal must be thoroughly emptied as 
it is before an operation. The substances commonly 
administered for the purpose of outlining the alimen- 
tary canal are bismuth subcarbonate, oxide or oxy- 
chloride and barium sulphate. Several hours before 
the picture is to be taken about two ounces of one of 
these substances are given by mouth or rectum (accord- 
ing to the part to be photographed) in some thick, 
pasty food such as cereal, buttermilk, or thick soup. 
Before photographing the urinary organs a solution 
of a silver salt may be injected into the bladder or 
ureters. 

It is now known that an away apparatus generates 
rays similar to, if not identical with, gamma rays, a 
type of rays given off by radium and radio-active 
metals which are of greatest therapeutic value. This 
explains the fact that treatment by ar-rays or by radium 



302 RAY THERAPY 

may give equally good results in similar affections. 
Various skin diseases, small tumors, tubercular glands, 
chronic ulcers and leukemia are treated by the arrays 
and its effects are almost specific in epithelioma and 
tubercular adenitis. The same apparatus is used for 
treatment as for photography with lower currents and 
longer exposures. The rays are confined to the area 
to be treated by means of lead cylinders and their 
activity is regulated by screens, usually of aluminium. 
There is no way for a nurse to learn to assist in 
axray work except by experience. This field offers 
an opportunity for a nurse to become expert in a 
specialized and important line of work but it is trying 
on the health because of the long periods of time 
which have to be spent in the dark-room. 

RADIUM. 

The discovery of radium and radio-activity was a 
direct result of experimentation with the arrays . 
Becquerel, a French scientist, first discovered that 
certain natural substances such as the metal uranium 
have the property of giving off streams of tiny atoms 
at a great velocity, these streams being similar to rays 
of light which are waves of ether. Such substances 
are said to be radio-active. 

Shortly after Becquerel's discovery M. and Mme. 
Curie of France commenced their study of ores which 
contained uranium. They found that some of the ores 
were more radio-active than uranium itself and there- 
fore must contain some unknown element. By a most 



RADIUM 



303 



laborious process, every step of which involved original 
research, they isolated in 1898 three new substances, 
one of which was radium chloride. Mine. Curie later 
obtained pure radium which is usually used in medi- 
cine in the form of the bromide, a brown, rather 
finely divided powder. 

Radium and its salts give off three different kinds 
of rays, the alpha (a), beta (,3), and gamma (/'). They 
are separated from one another in practice by inter- 



X 


'.Z.a—— 


: -\ p.v. 







■-?=■—.. 



Fig. 30. — Varying penetrability of radium rays: x, tube of radium 
bromide; A, piece of paper; D, sheet of lead. 



posing screens which are penetrable by one kind and 
not by the others. A piece of paper will filter off the 
alpha rays, and a thin sheet of lead the beta, leaving 
the gamma rays. The separation in practice is never 
as complete as is indicated in Fig. 30. 

Alpha rays have little power of penetration. They 
are absorbed by the skin and as tissues are affected 
only by the rays which are absorbed by them, not by 
those which pass through, they are probably responsible 



304 RAY THERAPY 

for the effect of radium rays on the skin. Beta rays 
are much more penetrating than the alpha, more 
numerous, and probably have some curative power. 
Gamma rays have a very great power of penetrability, 
some of them being able to pass through every part 
of the human body. They are comparatively few in 
number but at the present time they are credited with 
the beneficial effects of radium on pathological tissues. 

The exact nature of the action of radium on living 
tissue is not known. A few days after the application 
of unscreened radium rays on healthy skin redness 
and tenderness appears and a scab may form which, 
on peeling, leaves a fresh, soft skin. If a very strong 
radiation is given a suppurating ulcer will form which 
readily heals. In tumors the newly formed cells either 
disintegrate or atrophy, in cancers the cancerous 
tissue is partly destroyed and partly inhibited in 
growth. Radium has proved especially useful in a 
serious form of ulcer called rodent ulcer. Its use has 
met with much success in treatment of warty growths, 
swollen, malignant, and tubercular glands, malignant 
growths, lupus, keloids, fibroid tumors of the uterus, 
uterine hemorrhages, and corneal ulcers. In cases 
which are not cured it lessens pain, checks suppura- 
tion, removes foul odors, and practically always causes 
some retrogression. 

Radium is kept in sealed glass tubes which are 
frequently enclosed in gold, silver or platinum for 
protection and as a filter for the alpha rays. These 
tubes are about one-quarter of an inch in diameter, 
three-quarters to two inches in length, and contain 



RADIUM 305 

from 80-120 mg. of the bromide according to their 
size. They may be imbedded in a tumor or cancer, 
inserted into the various openings of the body, such 
as the rectum or vagina, placed directly on the skin 
over the affected part, or held some distance away 
from the part that the radiation may spread over a 
larger area. For strong radiation a tube may be used 
without screening but often sheets of lead are placed 
between the tube and the surface being treated to 
filter out all except the gamma rays. The factors 
which determine the dosage of radium rays are the 
amount of radium, the degree of screening, the dis- 
tance away from the part treated, and the duration 
of the exposure. An exposure may last from one-half 
hour to several hours. 

Treatments by radium and the .r-rays are frequently 
combined. For example a tube of radium may be 
imbedded in a tumor and external radiation given by 
the .r-rays. The initial expense of radium is great but 
a tube can be used repeatedly over an indefinite 
period without any apparent loss of radio-activity. 
The advantages of radium over the .r-rays are the 
absence of elaborate equipment, the ease with which 
it can be transported to the bedside, the fact that it 
can be applied directly within the tissues, and the 
accuracy with which a dose can be measured. In 
certain cases radium produces better results, in others 
the .r-rays, and sometimes either may be used with 
equally good results. 

Thorium and mesothorium, two less expensive 
radio-active metals, are being used to some extent in 
20 



306 RAY THERAPY 

place of radium. Emanation, a product of radium, 
also has some use. Emanation is a gas which is given 
off from radium and is easily collected from the surface 
of a solution of a radium salt. It is more radio-active 
than radium but its activity lasts only a few days 
against 2500 years in the case of radium. It is used in 
sealed tubes in the same way as radium, by inhalation 
for inflammatory conditions of the respiratory tract, 
and in solution in water as internal medicine or in 
baths for rheumatism and disorders of the nerves. 



INDEX. 



Absorbent, 183 
Acacia, 175 

Acetanilid, 94, 129, 132 
Acids, 69 

acetic, 67, 71, 72, 73 

administration, 73 

antidotes for, 67 

antilithics, 207 

antizymoti.es, 71 

arsenous, 71, 166, 167 

astringents, 72 

carbolic. See Phenol. 

caustics, 71 

chemical action, 70 

citric, 73, 162 

experiment. 260 

fruit, 71, 180 

hydriodic, 249 

hydrochloric, 71 

hypochlorous, 237 

lactic, 72 

nitric, 71 

organic, 73 

oxalic, 67 

phosphoric, 71 

picric, 241 

solvents, 72 

stimulants, 71 

sulphuric, 72 

supply deficiency, 69 

tartaric, 73 

trichloracetic, 71 
Aconite, 138, 157, 214 
Actinic rays, 297 
Active principles, 80, 261 
Adnephrin, 159 



Adonis vernalis, 247 
Adrenalin, 159 
Agar-agar, 247 
Agaricin, 202 
Agurin, 205 
Albargin, 238 
Albolene, 196 
Alcohol, antidote, 67, 113 

class name, 107, 109 

denatured, 110 

ethyl, 110 

grain, 110 

methyl, 109 

preparations, 110 

solutions in, 42 

styptic, 240 

uses, 113 

wood, 109 
Aldehydes, 108 
Alkalies, 69 

administration, 73 

antidote, 67 

caustic, 71 

neutralization, 70 

solvents, 72 

stimulants, 71 

supplv deficiencv, 69 
Alkaloids, 67, 83, 261 
Aloes, 190, 193 
Aloin, 193 
Alteratives, 211 
Alum, 239 
Aluminium, 239 
Ammonium acetate, 172, 201 
207, 214 

aromatic spt., 110, 171 

carbonate, 171, 177 

chloride, 172, 177 



308 



INDEX 



Ammonium, counter-irritant, 
231 

heart stimulant, 156 

hydroxide, 171 
Amnoform, 203 
Amyl nitrite, 152, 154 
Analgesics, 127 
Anaphrodisiacs, 226 
Anaphylaxis, 293 
Anesthetics, general, 120 

local, 133 
Anhidroses, 200, 202 
Anise, 247 
Anodynes, 137 
Antacids, 161 
Antagonistic action, 85 
Anthelmintics, 198 
Antidiarrheics, 197 
Antidotes, 64 
Antiemetics, 181 
Antikamnia, 130 
Antilithics, 207 

Antimony and potassium tar- 
trate, 176 
Antiperiodic pills, 217 
Antiphlogistine, 231 
Antipruritics, 236 
Antipyretics, 214 
Antipyrine, 129 
Antiseptic solution, 238 
Antiseptics, intestinal, 185 

respiratory, 173 

urinary, 203 
Antispasmodics, 142 

respiratory, 173 
Antisyphilitics, 218 
Antithyroids, 213 
Antitoxin, 290 

diphtheria, 162, 290 

tetanus, 290 
Antizymotics, 71 
Aphrodisiacs, 226 
Apinol, 247 
Apiol, 247 
Apocynum, 247 
Apomorphine, 66, 176, 180 
Apothecaries' tables, 21, 22 
Aqua, 41, 257 
Argonin, 238 
Argyrol, 238 
Arheol, 204 



Aristol, 199, 236 
Arnica, 247 
Arsacetin, 221 
Arsenic, 67, 165, 226 

acids, 71, 166 

oxide, 166 

salts, 79 
Arsenophenylglycin, 221 
Asafetida, 143, 186 
A. S. and B. pills, 91, 194 
Ascitic fluid, 162 
Aspidium, 198 
Aspidosperma, 247 
Aspirin, 131, 224 
Astringents, 239 
Atophan, 224 
Atoxyl, 167, 221 
Atropine, 95, 138 

anaphrodisiac, 227 

in anesthesia, 126 

anhidrotic, 202 

anodyne, 138 

antispasmodic, 143 

heart stimulant, 156 

mydriatic, 140 

respiratory sedative, 172 
stimulant, 170 

with coal tars, 132 
Autogenous serum, 293 
Avicenna, 57 
Avoirdupois weights, 23 



B 



Balsam of Peru, 240 
Barium sulphate, 301 
Baths, acid, alkaline, 71, 72, 73 

brine, 278 

cold water, 275 

electric, 283 

hot water, 274 

light, 296, 298 

mineral water, 278 

mud, 278 

oxygen, 279 

Russian, 279 

sprudel, 278 

Turkish, 279 
Basham's mixture, 165, 201, 207 
Beebe's serum, 214 



INDEX 



309 



Belladonna, 95 
Benzoates, 128 
Benzoin, 174. 240 
Beta rays, 304 
Betanaphtol, 247 
Bile salts, 189 
Bismal, 197 
Bismuth, 181, 197, 301 
Bitter orange, 184 
Black draught, 191 

wash, 234 
Blackberry, 198 
Blood root, 250 
Blue mass, 188 

ointment, 219, 234 
Bolus, 46 
Boneset, 247 

Boric acid, antiseptic, 71, 238 
burns, 241 

saturated solution, 38 
Borolyptol, 238 
Bromides, 118, 143, 156 
Bromidia, 117 
Bromipin, 248 
Bromoform, 248 
Broom, 250 
Brown mixture, 177 
Buchu, 203, 206 



Cacao butter, 46, 250 

Cachet, 46 

Caffeine, 92 

central stimulant, 92 
diuretic, 93, 205 
heart stimulant, 156 
respiratory stimulant, 70 

Calabar bean, 141 

Calamus, 184 

Calcium, 78, 162, 210 

Calomel, anthelmintic, 199 
antiseptic, 185, 234 
cathartic, 187 
diuretic, 206 

Camphor, anodyne, 139 
carminative, 186 
central stimulant, 94 
counter-irritant, 231 
heart stimulant, 95, 156 



Camphor, respiratory stimu- 
lant, 170 

Camphorated oil, 94 

Camphoric acid, 202 

Canada balsam, 43 

Cannabis indica, 248 

Cantharides, 206, 226, 232 

Capsicum, 143, 186, 206, 232 

Capsule, 46 

Carbolic, 128 

Carbosant, 204 

Cardamom, 184 

Carminatives, 185 

Cascara, 190, 191 

Castor-lax, 190 

Cataphoresis, 287 

Catechu, 248 

Cathartics, 187 
table of, 196 

Caustic soda, 248 

Caustics, 71, 230, 233 

Cauteries, 71 

Cayenne pepper. See Capsicum. 

Cerate, 45 

Cerium oxalate, 181 

Chalk, 45, 69, 197 

Chamomile, 249 

Champagne, 111, 181 

Charcoal, 183 

Charta, 47 
sinapis, 47 

Chartula, 46 

Chenopodium, 199 

Chestnut leaves, 198 

Chloral, 117 

Chloralformamide, 248 

Chloretone, 126, 248 

Chloroform, 121, 231 

Chromium trioxide, 233 

Chrysarobin, 206, 248 

Cinchona, 184, 216 

Cinchonidine, 218 

Cinchonine, 218 

Citrates, 162 

Claret, 198 

Clay poultices, 231 

Coagulability of blood, de- 
creased, 162 
increased, 161 

Coal-tar analgesics, 129, 214 
derivatives, 128 



310 



INDEX 



Cocaine, antimetic, 181 

local anesthetic, 133 

mydriatic, 141 
Codeine, 105, 127, 172 
Cohosh, 228 
Colchicum, 248 
Collodion, 43 
Colocynth, 190 
Colonial spirit, 109 
Columbian spirit, 109 
Compound effervescing powder, 
46, 195 

laxative pills, 91 
Copaiba, 203, 204, 206 
Copper salts, 78 

sulphate antidiarrheic, 248 
antidote, 67 
caustic, 233 
emetic, 66, 180 
Corpus luteum, 228 
Cotarnine, 249 
Counter-irritants, 230 
Cox's hive syrup, 177 
Cramp bark, 228 
Creolin, 128, 248 
Creosote, 173, 185 
Cresol, compound solution of, 

128 
Cresols, 128 
Cubebs, 203, 204 
Cusso, 248 



Dandelion, 184 
Defibrinated blood, 162 
Delphinium, 250 
Demulcents, 42, 64 

respiratory, 175 
Depressants, central, 101 

diagram, 115 

heart, 156 
Dermatol, 197 
Diaphoretics, 200 
Diastase, 182 
Diathermy, 286 
Diazyme, 183 
Digestants, 181 
Digipuratum, 151 
Digitalein, 151 
Digitalin, 82, 151 



Digitalis, 145, 157, 206 
Digitoxin, 151 
Dionine, 248 
Dioscorea, 228 
Dioscorides, 56 
Disinfectants, 234, 237 
Diuretics, 204 
Diuretin, 205 
Dobell's solution, 38 
Dogwood bark, 198 

Jamaica, 228 
Donovan's solution, 167 
Dosage, 47 

factors determining, 48 

for children, 48 

for infants, 48 

fractional doses, 49 
Dover's powder, 104, 201, 214 
Drastics, 187, 196 
Drug, defined, 53 

for demonstration, 89 

markets, 81 

vegetable, 80 
Duboisine, 248 



E 



Ecbolics, 228 
Effervescing powders, 46 
Elaterin, 190 
Electrical currents, 285 
Elixirs, 42 
Emanation, 306 
Emetics, 180 
Emetine, 225 
Emmenagogues, 227 
Empiric remedy, 86 
Emplastrum, 46 
Emulsion, 45, 47 
Enemas, 194 
Epinephrine, 138 

ecobolic, 228 

hemostatic, 240 

vasoconstrictor, 158 
Epispastics, 230, 232 
Epsom salts, 194 
Equivalents, 24 
Ergot, 229 
Ergotoxine, 138, 160 
Erythrol tetranitrate, 153, 154 
Erythroxylon coca, 133 



INDEX 



311 



Eserine, 142 
Ether, class, 108 

compound spirit, 144 

ethyl, 121, 141 

spirit of nitrous, 202 
Ethyl chloride, 121, 137 

nitrite, 202 
Eucaine, 136 
Eucalyptol, 175 
Eucalyptus. See Oil of. 
Euphthalmin, 248 
Europhen, 236 
Expectorants, 176 
Extracts, 43, 44, 47 



Faradic electricity, 283 

Fennel, 249 

Ferratin, 165 

Ferric chloride, tincture of, 

165, 240 
Flexible collodion, 43 
Fluidextracts, 44, 47 
Formaldehyde, 108 
Formin, 203 

Fowler's solution, 167, 257 
Frangula, 249 
Friction, 231, 274 



Galenical, 56 
Galvanic electricity, 282 
Gambir, 248 
Gamboge, 84, 190 
Gamma rays, 301, 303, 304 
Gaultheria, 139 
Gelsemium, 249 
Gentian, 138, 184 
Ginger, 249 
Ginseng, 226 
Glauber's salt, 249 
Glonoin, spirit of, 154 
Glucosides, 67, 82, 261 
Glycerin, 194 
Glycerite, 42 
Glycerophosphates, 209 
Glyceryl trinitrate, 154 



44. 



Glycothymoline, 238 
Glycyrrhiza, 175 
Goa powder, 206 
Granule, 46 
Gray powder, 188, 219 
Grindelia, 249 
Guaiacol, 173, 185 
Guaiacum, 249 
Guarana, 92 
Gum, 45 
arabic, 175 



Hahnemann, Dr., 59 
Hamamelis, 84, 198 
Harrison act, 264 
Heat, dry, 230 

electrical, 286 

sedative, 274 

stimulant, 274 

wet, 230 
Heliotherapy, 295 
Helmitol, 203 
Hemaboloids, 165 
Hemogallol, 165 
Hemoglobin, 165 
Hemostatic, 159, 240 
Heroin, 105 

Hexamethylenamine, 203 
Hick's capudine, 130 
Hidrotics, 200 
High wine, 110 
Hippocrates, 55 
Hoffmann's anodyne, 144 
Homatropine, 140 
Homeopathy, 59 
Hops, 249 
Hormonal, 249 
Household measures, 23 
Hydrargyri chloridum mite, 188 
Hydrargvrum, 188 
Hydrastfne, 249 
Hvdrastinine, 228, 249 
Hydrastis, 228, 249 
Hydrated chloral, 117, 143, 156 
Hydrocarbons, 107 

derivatives, 108 

radicals, 108 

series of, 107 



312 



INDEX 



Hydrogen peroxide, 67, 234, 237 
Hyoscine, 99 
Hyoscyamine, 99 
Hvoscyamus, 99, 100, 127, 227 
Hypnotics, 116 
Hypnotism, 268 
Hypophosphites, 209 



Ichthyol, 234 
Infra-red rays, 297 
Infusion, 43, 47 
Iodides, expectorants, 177 

in nutrition, 211 
Iodine antidote, 67 

disinfectant, 234, 235, 237 

tincture of, 44 
Iodoform, 236 
Iodol, 236 
Iodothyrin, 213 
Ipecac, 66, 104, 176, 180 
Ipecacuanha, 176 
Iron, aphrodisiac, 226 

experiment, 262 

hematinic, 163 

styptic, 240 



Jaborandi, 142 
Jalap, 84, 190 



Kaolin, 231 
Kino, 198 
Kola, 92 
Konseal, 46 
Krameria, 198 



Labarraque's solution, 237, 

248 
Lady Webster's dinner pill, 193 
Lanolin, 45 



Larkspur, 250 
Laudanum, 58, 106 
Laxatives, 187, 196 
Lead salts, 78 
acetate, 77 
subacetate, 79, 240 
Lecithin, 210 
Licorice, 175 

compound mixture, 177 
powder, 175, 191 
Lime-water, alkali, 70 

anthelmintic, 199 

antidiarrheic, 197 

antidote, 67 

antiemetic, 181 

solvent, 72 
Liniment, 45 
Liquor, 41 
Listerine, 238 
Lobelia, 249 
Lugol's solution, 249 
Lysol, 128, 238 



M 

Magendie's solution, 106 
Magnesium carbonate, 67, 70 

citrate, 66, 71, 194 

milk of, 67 

oxide, 67 

salts, 78 

sulphate, 66, 194 
Male fern, 198 
Malt extracts, 183 
Mammary gland, 228 
Manna, 249 
Materia medica, denned, 53 

history, 55 
Matricaria, 249 
Medicine, administration, 61 

defined, 53 

local, 69 

systemic, 69 
Medinal, 118 
Menstruum, 41 
Mentha piperita, 139 
Menthol, 138, 231 
Mercury, antisyphilitic, 58, 218 

bichloride, solution of, 38 

cathartic, 188 



INDEX 



313 



Mercury, caustic, 76 

disinfectant, 234 

salts of, 78 
Mesotan, 224 
Mesothorium, 305 
Methyl salicylate, 139, 224 
Methylene blue, 128 
Metric system, table of weights, 
18 
of volume and length, 20 
Mineral water, antilithic, 207 
as beverage, 278 
in baths, 278 
Mistura, 45 
Mixture, 45 

Basham's, 165, 201, 207 

chalk, 197 

licorice, 175 

rhubarb and soda, 193 
Morphine, 101 

analgesic, 127 

in anesthesia, 126 

antiemetic, 181 

antispasmodic, 143 

central depressant, 101 

diaphoretic, 201 

discovered, 60 

heart sedative, 156 

hypnotic, 116 

on pupil, 141 

respiratory sedative, 172 
Mucilage, 42, 258 
Mustard, active principle of, 
82 

counter-irritant, 231, 232 

emetic, 66, 180 
Mydriatics, 140 
Myotics, 141 
Myrrh, 186, 240 



N 

Narcosis, 116 

Narcotine, 105 

National Formulary, 39 

Neosalvarsan, 221 

Nervous system, 85 

action of drugs on, 88 
classes of drugs, 88 
diagram of, 87 



New and non-official remedies, 

40 
Nitre, sweet spirits of, 202 
Nitrites, antispasmodics, 143 

muscle depressants, 152 

respiratory sedative, 172 

vasodilators, 158 
Nitroglycerine, 153, 154 
Nitrous oxide, 121, 127 
Normal saline, 38 
Novargon, 238 
Novaspirin, 224 
Novocaine, 136 
Nux vomica, 89, 184 



Oak bark, 198 
Oils, 81, 261 

birch, 139 

cade, 235 

Carron, 240 

castor, 66, 189 

chenopodium, 199 

cloves, 82, 249 

croton, 189 

eucalyptus, 173, 174 

fixed, 81 

juniper, 111 

linseed, 82 

mineral, 196 

olive, 82, 189 

peppermint, 82, 143, 186 

Russian, 196 

santal, 203, 204, 206 

theobroma, 250 

turpentine, 82 
anthelmintic, 199 
carminative, 186 
counter-irritant, 231 
kidney irritant, 206 

volatile, 81 

wintergreen, 82, 139 
Ointment, 45 
Oleate, 42 
Oleoresin, 44, 84 
Oleum olivae, ricini, tiglii, 189 
Opium, 101 
Orangeine, 130 
Orthoform, 250 



314 



INDEX 



Ouabain, 151 
Ovarian extract, 228 
Ovoferrin, 165 
Ox-gall, 189 



Panase, 183 

Pancfeatin, 182 

Paper, 47 

Paracelsus, 58 

Paraldehyde, 119 

Paregoric, 106 

Pelletierine tannate, 250 

Pennyroyal, 227 

Pepo, 250 

Peppermint. See Oil of. 

Pepsin, 182 

Petrolatum, 45, 196 

Pharmaceutical preparations, 

39, 257 
Pharmacognosy, 53 
Pharmacology, 54, 59 
Pharmacopeia, 39, 56 
Pharmacy, 39 
Phenacetine, 129 
Phenalgin, 130 
Phenol, antidote for, 67 

disinfectant, 236 

solution, 5 per cent., 38 

source, 128 
Phenolphthalein, 128, 191 
Phosphorus, 209 
Phylacogens, 292 
Physiological action, 85 
Physostigmine, 138 

cathartic, 145, 195 

myotic, 141 
Phytolacca, 250 
Pill, 45 
Pilocarpine, 138 

diaphoretic, 201 

myotic, 142 

nutrition, 214 
Piperazine, 250 
Pituitary extract, 145 
diuretic, 206 
ecbolic, 228 
muscle stimulant, 155 
vasoconstrictor, 158 
Pituitrin, 155 



Plaster, 46 
Podophyllin, 84, 188 
Podophyllum, 188 
Poisons, defined, 53 
experiment, 261 
gases, 66 
irritant, 66 
legislation, 263 
non-irritant, 66 
Poke root, 250 
Posology, 47 
Potassium salts, 78 
acetate, 206 
arsenite, 167 
bicarbonate, 207 
bitartrate, 207 
carbonate, 73 
citrate, 207 
nitrate, 153, 154 
permanganate, 37, 67, 83 
Powder, 46 
Prescriptions, 251 

hydrotherapeutic, 274 
origin of fy 55, 252 
shotgun, 58, 182, 218 
Proof spirit, 110 
Protargol, 238 
Pulsatilla, 228 
i Pulvis, 46 
| Pumpkin seed, 250 
i Pure food and drugs act, 265 
j Purgatives, 187, 196, 227 
Pyramidon, 131 
Pyrogallol, 128, 233 
Pyroxylin, 43 



Quassia, 184, 199 
Quillaja, 82 
Quinidine, 218 

Quinine and urea hydrochloride, 
137 

antimalarial, 216 

antipyretic, 215 

stomachic, 184 



Radium, 302 
Rational remedy, 86 



INDEX 315 


Rectified spirit, 110 


Scopolamine, twilight sleep, 100 


Resins, 83, 2&2 


Sedatives, respiratory, 172 


Resorcin, 128, 237 


uterine, 227 


Rhamnus purshiana, 191 


Seidlitz powder, 46, 195 


Rheum, 192 


Selective action, 76 


Rhubarb, 191 


Senega, 250 


Risicol, 190 


Senna, 190, 191 


Rochelle salts, 71, 195 


Serturner, 60 


Rontgen rays, 299 


Serum, 288 


Rubefacients, 232 


Sialogogues, 180 


Rue, 227 


Side actions, 86 


Russian oil, 196 


Silver salts, 234 




caustic, 77, 233 




citrate, 238 


S 


disinfectant, 238 


lactate, 238 




nitrate, 67, 77, 238 


Saccharin, 250 


Slippery elm, 175 


Salicin, 82, 224 


Sodium salts, 78 


Salicylates, 128, 216, 223 


arsanilate, 221 


Saline cathartics, 194 


bicarbonate, alkali, 67, 


Salol, 128, 185, 203 


70, 161, 181 


Salophen, 250 


bath, 73 


Salt action, 75, 280 


burns, 241 


Salt-free diet, 207 


diuretic, 207 


Salts, 75 


with coal tars, 132 


alkali, 69, 73 


cocodylate, 167, 221 


astringent, 76 


carbonate, 161 


caustic, 76 


chloride, 67, 199, 241 


chemical action, 76 


glycocholate, 189 


changes, 77 


hypochlorite, 237 


experiment, 261 


nitrite, 152 


metallic, 67 


phosphate, 194 


toxicity of, 78 


sulphate, 249 


Salvarsan, 221 


taurocholate, 189 


Sanquinaria, 250 


Solubility, 27, 256 


Santonin, 198 


Solutions, 27 


Santyl, 204 


alcoholic, 42 


Saponins, 82, 262 


aqueous, 41 


Sarsaparilla, 82, 250 


method of making, 33 


Sassafras, 175 


parts of, 27 


Savin, 227 


pharmaceutical, 41, 257 


Scammony, 190 


saturated, 28 


Scilla, 177 


strength of, how expressed, 


Scoparius, 250 


28 


Scopola, 99, 101 


how reckoned, 29, 30 


Scopolamine, anesthesia, 126 


relative, 32 


antispasmodic, 143 


table of, 37 


mydriatic, 141 


true, 27, 256 


sedative, 100 


Somnal, 117 


source, 99 


Somnos, 117 



316 



INDEX 



Spanish flies, 232 
Sparteine, 250 
Spigelia, 250 
Spirit, 42 
Spiritus frumenti, 110 

vini galli, 110 
Squibb's diarrhea mixture, 95 
Squill, 177 

compound syrup, 177 

vinegar of, 177 
Staphisagria, 250 
Static electricity, 280 
Stavesacre, 250 
Stimulants, central, 89 

diagram, 115 

heart, 156 

kidney, 205 

muscle, 155 

respiratory, 170 
Stock vaccine, 293 
Stoke's expectorant, 177 
Stomachics, 183 
Stovaine, 136 
Stramonium, 99, 101, 173 
Strophanthin, 151 
Strophanthus, 145, 157, 206 
Strychnine, 89 

aphrodisiac, 226 

central stimulant, 89 

heart stimulant, 156 

respiratory stimulant, 170 

tonic, 90 

with coal tars, 132 
Styptic, 240 
Stypticin, 249 
Sudorifics, 200 
Sugar, 240 
Suggestion, 269 
Sulphonal, 118 
Sulphur, 195, 234 
Sumach, 198 
Sun cholera drops, 94 
Suppository, 46 
Supracapsulin, 159 
Suprarennin, 159 
Suspension, 27, 45, 256 
Sweet flag, 184 
Sydenham, Dr., 58 
Synergistic action, 85 
Syrup, 42, 44 

of figs, 191 



Tablet triturate, 45 
Taka-diastase, 182 
Tamar Indien, 191 
Tannin, 83, 84 

antidiarrheic, 198 

antidote, 67 

astringent, 240 

experiment, 262 
Tansy, 227 
Tar, 235 
Taraxacum, 184 
Tartar emetic, 176 
Tea, 67, 198 
Terpin hydrate, 178 
Tetronal, 118 
Therapeutics, 54 
Theobromine, 205 
Theocin, 206 
Theophyllin, 206 
Thiersch's solution, 37 
Thiol, 235 
Thorium, 305 
Thymol, 199 
Thyreoidectin, 213 
Thyresol, 204 
Thyroid, 212 
Thvroiodine, 213 
Tincture, 43, 47 
Tolu, tincture of, 44 
Tonics, heart, 157 

muscle, 145 
Toxicology, 64 
Tragacanth, 250 
Trional, 118 
Triturate, 45 
Troche, 46 
Tropococaine, 136 
Turpentine. See Oil of. 

Canada, 43 
Twilight sleep, 100 
Tyramine, 160 



Ultra-red rays, 297 
Ultra-violet rays, 297 
Unguentum, 45 
Untoward action, 86 



INDEX 



317 



Urea hydrochloride, 137 
Urotropin, 203 
Uterine sedatives, 227 
Uva ursi, 206 



Vaccine, 288 

Valerian, 143 

Vaseline, 241. See Petrolatum. 

Vasoconstrictors, 158 

Vasodilators, 158 

Veratrum, 157 

Veronal, 118 

Viburnum, 227 

Vinegar, 177 

Vinum, 44 

Vulneraries, 240 



W 

Warburg's tincture, 217 

Water, 41, 257 
cathartic, 187 
external use, 273 
internal use, 273 



Weights and measures, 17 

use and care of, 25 
White precipitate ointment , 23 \ 
Wild cherry, 173 
Wine, 44 
Wintergreen. See Oil of. 



Xeroform, 197 
X-rays, 299 



Yam, 228 
Yellow dock, 198 

wash, 234 
Yerba santa, 218 



Zinc salts, 78, 237, 240 
sulphate, 66, 180, 237 
Zingiber, 249 




DDDEblDllEfl 



